Does Fairview Park Hospital have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Fairview Park Hospital. In a medical emergency, call 911.

Where is Fairview Park Hospital?

200 Industrial Boulevard, Dublin, GA 31021, in Laurens County, Georgia.

What is the phone number of Fairview Park Hospital?

(478) 274-3100, as listed by Medicare (CMS).

What is the Medicare star rating of Fairview Park Hospital?

4 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-10-26).

Does Medicare reduce its payments to Fairview Park Hospital for hospital-acquired conditions?

No. For fiscal year 2026, CMS lists no Medicare payment reduction for Fairview Park Hospital under the Hospital-Acquired Condition Reduction Program (Total HAC Score: -1.1197; a lower score is better). It is an adjustment to what Medicare pays the hospital, not a charge to patients (CMS data released January 26, 2026).

Fairview Park Hospital — Phone, Address & ER

Quick answers

Does Fairview Park Hospital have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Fairview Park Hospital. In a medical emergency, call 911.
Where is Fairview Park Hospital?: 200 Industrial Boulevard, Dublin, GA 31021, in Laurens County, Georgia.
What is the phone number of Fairview Park Hospital?: (478) 274-3100, as listed by Medicare (CMS).
What is the Medicare star rating of Fairview Park Hospital?: 4 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-10-26).
Does Medicare reduce its payments to Fairview Park Hospital for hospital-acquired conditions?: No. For fiscal year 2026, CMS lists no Medicare payment reduction for Fairview Park Hospital under the Hospital-Acquired Condition Reduction Program (Total HAC Score: -1.1197; a lower score is better). It is an adjustment to what Medicare pays the hospital, not a charge to patients (CMS data released January 26, 2026).

Specialties and care areas^{[4][8][9][10][13][14][16][17]}

Surgical care
Sleep Center
Women's health
Spine and orthopedics
Heart and vascular care
Imaging
Wound care
Cardiology
Cardiac rehabilitation
Emergency care
Inpatient physical rehabilitation
Outpatient physical rehabilitation
Sleep disorders
Surgery

Conditions treated^{[5][6][8][9][10][11][13][16][17]}

Heart attack
Stroke
Chronic congestive heart failure
Peripheral artery disease
Stable angina
Chest pain
Burns
Diabetic wounds
Pressure injuries
Radiation injuries
Chronic obstructive pulmonary disease (COPD)
Lung cancer
Sleep apnea
Insomnia
Narcolepsy
Periodic limb movements
Osteoporosis
Spinal stenosis
Spinal fractures
Multiple sclerosis
Parkinson's disease

Treatments^{[5][6][8][9][10][16]}

Hyperbaric oxygen therapy
Negative pressure wound therapy
Compression therapy
Debridement
Biological skin applications
Cardiopulmonary rehabilitation
Stroke rehabilitation
Physical therapy
Occupational therapy
Speech therapy
Lymphedema therapy
Aquatic therapy
Lung cancer screening (low-dose CT)
TPA clot-busting drug for stroke

Procedures^{[4][5][7][9][10][11][13][14][15][17]}

Minimally invasive robot-assisted surgery
Cardiac catheterization
Angioplasty
Stent placement
Bypass surgery
Valve repair or replacement
Heart transplant
Echocardiography (ECHO)
Electrocardiography (EKG)
Stress tests
Telecardiology
CT scan
MRI scan
Nuclear medicine
Digital and 3D mammography
Ultrasound
X-ray
Polysomnography (sleep study)
Multiple sleep latency test
CPAP titration
Electromyography (EMG)
Modified barium swallow study
Hysterectomy
Bladder repair
Joint replacement (hip, knee, shoulder, elbow)
Lumbar disc replacement
Spine surgery
Spinal cord stimulation
Gastric sleeve
Gastric bypass
Adjustable gastric banding
Biliopancreatic diversion with duodenal switch
Appendectomy
Cholecystectomy
Hernia repair
Splenectomy
Endoscopy
Laparoscopic surgery
Cystoscopy

Programs and centers^{[4][5][6][7][8][9][13][14][15][16][17]}

Sleep Center
Chest Pain Center with PCI
The Wound Center
Women's Center
Inpatient rehabilitation program
Cardiac and pulmonary rehabilitation program
Pediatric emergency care
Outpatient imaging center
Same Day Surgery
Bariatric surgery center
Labor and delivery
Neonatal intensive care unit (Level II)

Emergency care (hospital website)^[4][8]

Emergency room	Yes
Open 24/7	Yes
Trauma designation	Level III
Stroke designation	Primary Stroke Center certified by The Joint Commission

Visiting and practical information

Visiting	Inpatient visiting 8:00 a.m. to 9:00 p.m.; limits apply by unit (e.g., two visitors in ER and inpatient rooms)^[12]
Parking	Same Day Surgery patients park on the right side of the hospital, behind the imaging center^[14]

Recognition^{[4][5][8][9][14][15]}

Chest Pain Center with PCI (American College of Cardiology)
Bariatric Surgery Center (MBSAQIP)
Sleep Center accreditation (American Academy of Sleep Medicine)
Accredited Sleep Center (American Academy of Sleep Medicine)
Accredited by American College of Radiology for breast ultrasound, mammography and stereotactic breast biopsy
ECHO Lab accreditation (Intersocietal Accreditation Commission)
Accredited Bariatric Surgery Center (ACS MBSAQIP)
Primary Stroke Center (The Joint Commission)
Stroke rehabilitation certification (The Joint Commission)
Joint Commission certification for knee and hip replacements
Healthgrades Patient Safety Excellence Award (2024, 2025, 2026)
Level III Trauma Center (Georgia Department of Health)
Diagnostic laboratory certified by the College of American Pathologists

Doctors and clinicians (287)

287 doctors and other clinicians list Fairview Park Hospital as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.

Main specialties

Doctors with a page on this site (287)

Aaron O. Williams, MDRadiation Oncology
Aaron T. Street, CNACertified Registered Nurse Anesthetist (CRNA)
Abdul M. Chaudhry, MDHospitalist
Adam Kachelman, DOFamily Practice
Adam M. Zelickson, MDDiagnostic Radiology
Aidan E. Blanchard, PAPhysician Assistant
Alan D. Justice, MDInternal Medicine
Albert Warren Jr., MDFamily Practice
Amanda C. PhillipsNurse Practitioner
Amar Patel, MDEmergency Medicine
Amber D. KingNurse Practitioner
Amy Blake, MDDermatology
Andre C. Lewis, MDInternal Medicine
Andre R. Johnson, MDEmergency Medicine
Andrew W. Gore, MDDiagnostic Radiology
Andy F. Williamson, MDFamily Practice
Anna H. PowellNurse Practitioner
Ansley B. Oliver, CNACertified Registered Nurse Anesthetist (CRNA)
Anthony Avino, MDVascular Surgery
Anthony E. Barnes, MDUrology
Anthony L. Howard Sr., MDInternal Medicine
Archie J. Champion, PAPhysician Assistant
Arnold M. Conforti, MDSurgical Oncology
Ashlee Tubb, NPNurse Practitioner

And 263 more: the button below opens the full list.

Other emergency rooms nearby

Hospitals that list emergency services, by straight-line distance (not driving distance).

Dublin VA Medical Center0.6 mi · Dublin, GA · Federal/VA Acute Care Hospital
Bleckley Memorial Hospital25 mi · Cochran, GA · Critical Access Hospital
Dodge County Hospital28 mi · Eastman, GA · Acute Care Hospital
Washington County Regional Medical Center33 mi · Sandersville, GA · Acute Care Hospital
Taylor Regional Hospital35 mi · Hawkinsville, GA · Acute Care Hospital

Find the closest emergency room to where you are → · Compare ER wait times

Other hospitals near Dublin

Emanuel Medical Center36 mi · Swainsboro, GA · Acute Care Hospital

All hospitals in Dublin · Hospitals in Laurens County · Hospitals near me

Nursing homes, hospice, home health and dialysis nearby

Medicare-certified providers within 25 miles, by straight-line distance. Hospice and home health care is given at home: their address is the office.

Nursing homes

Dublinair Health & Rehab0.1 mi · Dublin, GA · 3 of 5 stars
Dublin Trails of Journey LLC2.6 mi · Dublin, GA · 3 of 5 stars
Emerald Healthcare & Rehab of Dublin2.9 mi · Dublin, GA · 1 of 5 stars

All nursing homes in the state →

Hospice providers

Georgia Hospice Care3.7 mi · Dublin, GA · 5 of 5 stars
Remarkable Hospice3.7 mi · Dublin, GA

All hospice providers in the state →

Dialysis facilities

DaVita Laurens County Dialysis3.7 mi · Dublin, GA · 1 of 5 stars
DaVita Shamrock Dialysis3.7 mi · Dublin, GA · 2 of 5 stars
Dublin Dialysis Center3.7 mi · Dublin, GA · 2 of 5 stars

All dialysis facilities in the state →

Outpatient surgery centers nearby

Medicare-certified ambulatory surgery centers within 25 miles, by straight-line distance.

Dublin Eye Surgery Center3.7 mi · Dublin, GA
Georgia Dermasurgery Centers, Inc3.7 mi · Dublin, GA

All outpatient surgery centers in the state →

Community care nearby

Health centers, clinics, urgent care and pharmacies closest to this hospital, by straight-line distance, from official HRSA, Medicare and NPI Registry data. In a medical emergency, call 911.

Community health centers

Community Health Care Systems, Inc.- Laurens County0.6 mi · Dublin, GA · Community health center
Community Health Care Systems, Inc - Irish Healthcare1.8 mi · Dublin, GA · Community health center
Community Health Care Systems, Inc. Johnson County Schools18 mi · Wrightsville, GA · Community health center

Pharmacies

Georgia Blood and Cancer Pharmacy LLC3.7 mi · Dublin, GA · Pharmacy
L M Bass LLC3.7 mi · Dublin, GA · Community/retail pharmacy
Pal Home Diagnostics&Resp.Care3.7 mi · Dublin, GA · Pharmacy

About the Medicare star rating

CMS (the federal Medicare agency) gives many hospitals an overall rating from 1 to 5 stars, based on measures of mortality, safety, readmissions, patient experience and timely care. It is one piece of information: ask your doctor what matters for your care. See the full Medicare profile →

Medicare quality data

What Fairview Park Hospital reported to Medicare (CMS), the federal agency that publishes these results for hospitals nationwide. These are averages for many patients, not a prediction for any one person: ask your doctor what matters for your care. In a medical emergency, call 911.

What patients said (patient survey)

What this means: Patients who stayed overnight answered a national survey (HCAHPS) about their stay. More stars mean patients reported a better experience than at other hospitals. The percentages show how often patients gave the best answer, next to the national average.

Summary star rating (all survey topics)	3 of 5 stars
Overall rating of the hospital	4 of 5 stars
Would recommend the hospital	4 of 5 stars
Nurses communicated well	4 of 5 stars
Doctors communicated well	3 of 5 stars
Patients got help quickly from staff	3 of 5 stars
Staff explained medicines	2 of 5 stars
Information about recovery at home	3 of 5 stars
Room and bathroom kept clean	3 of 5 stars
Restfulness of Environment	4 of 5 stars
Care Coordination	4 of 5 stars
Symptoms After Stay	3 of 5 stars
Rated the hospital 9 or 10 out of 10	74%National average: 72%
Would definitely recommend the hospital	73%National average: 71%
Nurses “always” communicated well	81%National average: 80%
Doctors “always” communicated well	79%National average: 80%
“Always” got help as soon as they wanted	62%National average: 64%
Staff “always” explained medicines before giving them	61%National average: 62%
Were given information about recovery at home	85%National average: 86%
Room and bathroom “always” clean	70%National average: 73%
Completed surveys	821Response rate: 18%

Source: Patient survey (HCAHPS) - Hospital — CMS, released October 19, 2026; patients discharged January 2025 to December 2025.

Infections caught in the hospital

What this means: CMS compares the number of infections patients caught in this hospital with the number expected for a hospital like it. The number shown is that ratio: below 1 means fewer infections than expected, above 1 means more. “Better” or “worse” is shown only when the difference is clear in the data.

Central line bloodstream infections (CLABSI)	0.222No different from the national benchmark
Catheter-associated urinary tract infections (CAUTI)	0.536No different from the national benchmark
MRSA bloodstream infections	0Better than the national benchmark
Clostridioides difficile (C. diff) intestinal infections	0Better than the national benchmark
Not reported to Medicare	Surgical site infections after colon surgery; Surgical site infections after abdominal hysterectomy

Source: Healthcare Associated Infections - Hospital — CMS, released October 19, 2026; data from January 2025 to December 2025.

Complications and deaths

What this means: Death rates are the share of patients who died within 30 days of going into the hospital for that condition, adjusted for how sick they were. PSI-90 combines several serious complications (a lower number is better). “No different from the national rate” is the most common result and means the hospital is in line with hospitals nationwide.

Deaths within 30 days: heart attack patients	14.5%
Deaths within 30 days: heart failure patients	10.7%
Deaths within 30 days: pneumonia patients	13.5%
Deaths within 30 days: COPD patients	7.5%
Deaths within 30 days: stroke patients	14.5%
Serious complications (patient safety indicator PSI-90)	1.04No different from the national rate
Not reported to Medicare	Deaths within 30 days: coronary bypass surgery (CABG)
Too few cases to report	Complications after hip or knee replacement

Source: Complications and Deaths - Hospital — CMS, released October 20, 2026; data from July 2022 to June 2025.

Return visits to the hospital (readmissions)

What this means: The share of patients who had to be admitted to a hospital again within 30 days after going home, adjusted for how sick they were. A lower percentage is better.

Returned to any hospital within 30 days (all patients)	17%
Readmitted within 30 days: heart attack	15.2%
Readmitted within 30 days: heart failure	21%
Readmitted within 30 days: pneumonia	17.7%
Readmitted within 30 days: COPD	21.2%
Too few cases to report	Readmitted within 30 days: coronary bypass surgery; Readmitted within 30 days: hip or knee replacement

Source: Unplanned Hospital Visits - Hospital — CMS, released October 20, 2026; data from July 2024 to June 2025.

Emergency room times and sepsis care

What this means: ER time is the middle (median) time from arriving at the emergency room to leaving it; busier ERs usually have longer times, so the ER volume is shown too. Leaving before being seen: a lower percentage is better. Sepsis is a life-threatening reaction to an infection; a higher percentage means more patients got every recommended early step.

Emergency room volume (patients per year)	High (40,000–59,999)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	140 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	0%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	77%National average: 66%

Source: Timely and Effective Care - Hospital — CMS, released October 19, 2026; data from January 2024 to December 2024.

See every measure on Medicare Care Compare →

Medicare payment programs

Medicare (CMS) uses these federal programs to adjust what it pays hospitals, based on quality, safety and cost results. This is a payment to the hospital for Medicare patients, not a price you pay, and not a prediction for any one person. Results for Fairview Park Hospital, fiscal year 2026 (October 2025 to September 2026).

Show the Medicare payment program results

Hospital-Acquired Condition Reduction Program

What this means: Medicare gives each hospital a Total HAC Score built from patient-safety complications and from infections caught in the hospital. The quarter of hospitals with the highest (worst) scores gets a reduction in its Medicare payments. A lower score is better.

CMS says: Hospitals with a Total HAC Score above the 75th percentile of the Total HAC Score distribution will be subject to a 1-percent payment reduction.

Medicare payment reduction, fiscal year 2026	NoCMS lists no payment reduction for this hospital.
Total HAC Score	-1.1197Lower is better. Hospitals above the 75th percentile of all scores get the reduction.

Source: Hospital-Acquired Condition (HAC) Reduction Program — CMS, released January 26, 2026; patient-safety data from July 2022 to June 2024 and infection data from January 2023 to December 2024.

Hospital Readmissions Reduction Program

What this means: For six conditions, Medicare compares how often this hospital’s patients had to go back into a hospital within 30 days with how often that happens at an average hospital with similar patients. The ratio is that comparison: 1 means as many readmissions as expected, above 1 means more than expected (CMS calls these “excess readmissions”), below 1 means fewer.

CMS says: In October 2012, CMS began reducing Medicare payments for subsection(d) hospitals with excess readmissions under the Hospital Readmissions Reduction Program (HRRP).

Heart attack	0.9871Fewer readmissions than expected
Heart failure	0.9969Fewer readmissions than expected
Pneumonia	1.0577More readmissions than expected
COPD (chronic lung disease)	1.0348More readmissions than expected
No result published	Hip or knee replacement; Coronary bypass surgery (CABG) (not reported, or too few cases)

Source: Hospital Readmissions Reduction Program — CMS, released January 26, 2026; patients discharged July 2021 to June 2024.

Hospital Value-Based Purchasing Program

What this means: Medicare scores hospitals in four areas, each from 0 to 100, and combines them into a Total Performance Score from 0 to 100. A higher score means better results on these measures. Medicare uses the score to adjust what it pays the hospital.

CMS says: This program adjusts payments to hospitals under the Inpatient Prospective Payment System (IPPS) based on the quality of care they deliver.

Total Performance Score	43.88 out of 100Median of the 2,455 hospitals in the program: 29.50
Clinical outcomes (deaths and complications)	2.50 out of 100
Person and community engagement (patient survey)	53.00 out of 100
Safety (infections and sepsis care)	90.00 out of 100
Efficiency and cost reduction (Medicare spending)	30.00 out of 100

Source: Hospital Value-Based Purchasing (HVBP) - Total Performance Score — CMS, released January 26, 2026, fiscal year 2026. Program description: The Hospital Value-Based Purchasing (VBP) Program — CMS, page last modified September 10, 2024.

Medicare spending per patient (MSPB)

What this means: This compares what Medicare spent on a hospital stay, counting the 3 days before it and the 30 days after, with the national median hospital, after adjusting for the patient’s age and health and for local prices. A ratio of 1.00 is the national median hospital; below 1.00 means Medicare spent less, above 1.00 means more. It measures the cost to Medicare, not the quality of care.

CMS says: The Medicare Spending Per Beneficiary (MSPB) Measure shows whether Medicare spends more, less, or about the same for an episode of care (episode) at a specific hospital compared to all hospitals nationally.

Medicare spending per patient, ratio	0.96Below the national median hospital (1.00): Medicare spent less

Source: Medicare Spending Per Beneficiary - Hospital — CMS, released October 19, 2026; data from January 2024 to December 2024.

ER wait times and Medicare ratings nearby

How this hospital compares with others in the area, ranked only by official Medicare (CMS) numbers.

ER wait times in Georgia Best hospitals in Georgia

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 84 common services exactly as Fairview Park Hospital lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

Hospital charge: The hospital’s list price (“gross charge”) before any discount or insurance. Few people pay this amount.
Cash price: The price the hospital offers if you pay yourself, without insurance (“discounted cash price”).
Insurance rates: The lowest and highest amounts the hospital has agreed with any insurance plan for the service (“de-identified minimum and maximum”), and some of the rates it lists by insurer and plan. Your share depends on your deductible, copay and coinsurance.
Hospital and doctor fees: A service can have a hospital (facility) fee and a separate doctor (professional) fee; the total for your care can include both, plus other services.

How to use hospital prices: estimates, financial assistance and your rights →

Show the prices of 84 common services

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) In the file: OP VISIT LEVEL 3 NP	$975	$975	$130.65 – $877.50
New patient office visit (about 30–44 minutes): 10 of 35 insurance plan rates Aetna — HMO: $335.40 Aetna — MCR: $146.25 Aetna — NAP: $537.52 Aetna — OpenAccess: $335.40 Aetna — POS: $335.40 Aetna — PPO: $335.40 Aetna — QualifiedHealthPlan: $252.13 American Steel Products — COMM: $828.75 Amerigroup — MCD: $130.65 Centurion — PRISN: $269.98
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) In the file: OP VISIT LEVEL 4 NP	$1,070	$1,070	$143.38 – $963
New patient office visit (about 45–59 minutes): 10 of 35 insurance plan rates Aetna — HMO: $368.08 Aetna — MCR: $160.50 Aetna — NAP: $589.89 Aetna — OpenAccess: $368.08 Aetna — POS: $368.08 Aetna — PPO: $368.08 Aetna — QualifiedHealthPlan: $276.70 American Steel Products — COMM: $909.50 Amerigroup — MCD: $143.38 Centurion — PRISN: $296.28
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) In the file: OP VISIT LEVEL 5 NP	$1,547	$1,547	$207.30 – $1,392.30
New patient office visit (about 60–74 minutes): 10 of 35 insurance plan rates Aetna — HMO: $532.17 Aetna — MCR: $232.05 Aetna — NAP: $852.86 Aetna — OpenAccess: $532.17 Aetna — POS: $532.17 Aetna — PPO: $532.17 Aetna — QualifiedHealthPlan: $400.05 American Steel Products — COMM: $1,314.95 Amerigroup — MCD: $207.30 Centurion — PRISN: $428.36
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) In the file: OP VISIT LEVEL 3 EST	$975	$975	$130.65 – $877.50
Established patient office visit (about 20–29 minutes): 10 of 35 insurance plan rates Aetna — HMO: $335.40 Aetna — MCR: $146.25 Aetna — NAP: $537.52 Aetna — OpenAccess: $335.40 Aetna — POS: $335.40 Aetna — PPO: $335.40 Aetna — QualifiedHealthPlan: $252.13 American Steel Products — COMM: $828.75 Amerigroup — MCD: $130.65 Centurion — PRISN: $269.98
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) In the file: OP VISIT LEVEL 4 EST	$1,228	$1,228	$164.55 – $1,105.20
Established patient office visit (about 30–39 minutes): 10 of 35 insurance plan rates Aetna — HMO: $422.43 Aetna — MCR: $184.20 Aetna — NAP: $677 Aetna — OpenAccess: $422.43 Aetna — POS: $422.43 Aetna — PPO: $422.43 Aetna — QualifiedHealthPlan: $317.56 American Steel Products — COMM: $1,043.80 Amerigroup — MCD: $164.55 Centurion — PRISN: $340.03
Preventive checkup, new patient, age 18–39 CPT 99385 · Outpatient (no overnight stay) In the file: Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examin	Not listed in the file	Not listed in the file	$67.13
Preventive checkup, new patient, age 18–39: rates for 1 insurance plan Humana — TRICARE: $67.13
Preventive checkup, new patient, age 40–64 CPT 99386 · Outpatient (no overnight stay) In the file: Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examin	Not listed in the file	Not listed in the file	$81.63
Preventive checkup, new patient, age 40–64: rates for 1 insurance plan Humana — TRICARE: $81.63
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination	$2,035	$2,035	$165 – $3,383.48
Emergency room visit (moderate): 10 of 24 insurance plan rates Aetna Better Health of Georgia — MCD: $320 Amerigroup — MCD: $250 BCBS — HIX: $2,781.58 BCBS — HMO: $3,155.39 BCBS — Pathway: $2,781.58 BCBS — PPO: $3,383.48 Cigna — HMO: $2,676 Cigna — LocalPlus: $2,598 Cigna — OAP: $2,676 Cigna — PPO: $2,676
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) In the file: LVL 3 EMER DEPT	$2,035	$2,035	$447.70 – $1,831.50
Emergency room visit (moderate): 10 of 12 insurance plan rates Aetna — NAP: $1,121.90 American Steel Products — COMM: $1,729.75 Dodge County Hospital — COMM: $1,017.50 Leavitt Risk Partners — COMM: $610.50 Memorial Health Plan — COMM: $752.95 Memorial Health Plan — EMPLOYEEPLAN: $447.70 Memorial Health Plan — HEALTHGRAM: $691.90 MultiPlan — Complementary: $1,831.50 MultiPlan — Primary: $1,831.50 NovaNet — COMM: $1,831.50
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination	$2,516.75	$2,516.75	$165 – $3,648.87
Emergency room visit (moderately high): 10 of 24 insurance plan rates Aetna Better Health of Georgia — MCD: $565 Amerigroup — MCD: $250 BCBS — HIX: $2,999.74 BCBS — HMO: $3,402.88 BCBS — Pathway: $2,999.74 BCBS — PPO: $3,648.87 Cigna — HMO: $2,676 Cigna — LocalPlus: $2,598 Cigna — OAP: $2,676 Cigna — PPO: $2,676
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) In the file: LVL 4 EMER DEPT	$2,516.75	$2,516.75	$553.68 – $2,265.07
Emergency room visit (moderately high): 10 of 12 insurance plan rates Aetna — NAP: $1,387.48 American Steel Products — COMM: $2,139.24 Dodge County Hospital — COMM: $1,258.38 Leavitt Risk Partners — COMM: $755.02 Memorial Health Plan — COMM: $931.20 Memorial Health Plan — EMPLOYEEPLAN: $553.68 Memorial Health Plan — HEALTHGRAM: $855.70 MultiPlan — Complementary: $2,265.07 MultiPlan — Primary: $2,265.07 NovaNet — COMM: $2,265.07
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: Emergency department visit for the evaluation and management of a patient, which requires a medically appropriate history and/or examination	$3,746.25	$3,746.25	$165 – $7,100
Emergency room visit (high): 10 of 26 insurance plan rates Aetna Better Health of Georgia — MCD: $725 Amerigroup — MCD: $250 BCBS — HIX: $2,972.48 BCBS — HMO: $3,371.95 BCBS — Pathway: $2,972.48 BCBS — PPO: $3,615.69 Cigna — HMO: $2,676 Cigna — LocalPlus: $2,598 Cigna — OAP: $2,676 Cigna — PPO: $2,676
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) In the file: LVL 5 EMER DEPT	$3,746.25	$3,746.25	$824.17 – $3,371.63
Emergency room visit (high): rates for 10 insurance plans Aetna — NAP: $2,065.31 American Steel Products — COMM: $3,184.31 Dodge County Hospital — COMM: $1,873.13 Leavitt Risk Partners — COMM: $1,123.88 Memorial Health Plan — EMPLOYEEPLAN: $824.17 MultiPlan — Complementary: $3,371.63 MultiPlan — Primary: $3,371.63 NovaNet — COMM: $3,371.63 United — GlobalBenefitPlan: $1,685.81 United — OptionsPPO: $925.32

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) In the file: Basic metabolic panel (Calcium, total) This panel must include the following: Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Ch	$1,205.25	$1,205.25	$7.91 – $9.98
Basic metabolic panel (blood test): 10 of 39 insurance plan rates Aetna — HMO: $7.61 Aetna — MCR: $8.54 Aetna — OpenAccess: $7.61 Aetna — POS: $7.61 Aetna — PPO: $7.61 Aetna — QualifiedHealthPlan: $7.61 Aetna Better Health of Georgia — MCD: $8.88 BCBS — HIX: $7.91 BCBS — HMO: $9.31 BCBS — MCR: $8.71
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) In the file: BMP TOTAL CALCIUM	$1,205.25	$1,205.25	$161.50 – $1,084.72
Basic metabolic panel (blood test): 10 of 24 insurance plan rates Aetna — NAP: $664.45 American Steel Products — COMM: $1,024.46 Americas 1st Choice — MCR: $337.47 Amerigroup — MCD: $161.50 Centurion — PRISN: $333.73 City of Eastman — COMM: $1,024.46 Dodge Co Board of Commissioners — COMM: $1,024.46 Dodge County Hospital — COMM: $602.63 Graham Brothers Construction — COMM: $1,024.46 Leavitt Risk Partners — COMM: $361.57
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: Comprehensive metabolic panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Calcium, total (82310) Carbon	$1,444.25	$1,444.25	$9.87 – $12.46
Comprehensive metabolic panel (blood test): 10 of 39 insurance plan rates Aetna — HMO: $9.50 Aetna — MCR: $10.67 Aetna — OpenAccess: $9.50 Aetna — POS: $9.50 Aetna — PPO: $9.50 Aetna — QualifiedHealthPlan: $9.50 Aetna Better Health of Georgia — MCD: $11.09 BCBS — HIX: $9.87 BCBS — HMO: $11.62 BCBS — MCR: $10.88
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) In the file: COMP METABOLIC PANEL	$1,444.25	$1,444.25	$193.53 – $1,299.83
Comprehensive metabolic panel (blood test): 10 of 24 insurance plan rates Aetna — NAP: $796.22 American Steel Products — COMM: $1,227.61 Americas 1st Choice — MCR: $404.39 Amerigroup — MCD: $193.53 Centurion — PRISN: $399.91 City of Eastman — COMM: $1,227.61 Dodge Co Board of Commissioners — COMM: $1,227.61 Dodge County Hospital — COMM: $722.13 Graham Brothers Construction — COMM: $1,227.61 Leavitt Risk Partners — COMM: $433.27
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) In the file: Obstetric panel This panel must include the following: Blood count, complete (CBC), automated and automated differential WBC count (85025 or	Not listed in the file	Not listed in the file	$47.81 – $56.42
Obstetric blood test panel: 10 of 39 insurance plan rates Aetna — HMO: $43.03 Aetna — MCR: $48.29 Aetna — OpenAccess: $43.03 Aetna — POS: $43.03 Aetna — PPO: $43.03 Aetna — QualifiedHealthPlan: $43.03 Aetna Better Health of Georgia — MCD: $32.99 BCBS — HIX: $44.70 BCBS — HMO: $52.59 BCBS — MCR: $49.24
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: Lipid panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholester	$902	$902	$11.47 – $23.31
Cholesterol panel (lipid panel): 10 of 39 insurance plan rates Aetna — HMO: $12.05 Aetna — MCR: $13.52 Aetna — OpenAccess: $12.05 Aetna — POS: $12.05 Aetna — PPO: $12.05 Aetna — QualifiedHealthPlan: $12.05 Aetna Better Health of Georgia — MCD: $14.06 BCBS — HIX: $12.52 BCBS — HMO: $14.73 BCBS — MCR: $13.79
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) In the file: LIPID PANEL	$902	$902	$120.87 – $811.80
Cholesterol panel (lipid panel): 10 of 24 insurance plan rates Aetna — NAP: $497.27 American Steel Products — COMM: $766.70 Americas 1st Choice — MCR: $252.56 Amerigroup — MCD: $120.87 Centurion — PRISN: $249.76 City of Eastman — COMM: $766.70 Dodge Co Board of Commissioners — COMM: $766.70 Dodge County Hospital — COMM: $451 Graham Brothers Construction — COMM: $766.70 Leavitt Risk Partners — COMM: $270.60
Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: Renal function panel This panel must include the following: Albumin (82040) Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chlo	$1,618.25	$1,618.25	$8.12 – $10.24
Kidney function panel: 10 of 39 insurance plan rates Aetna — HMO: $7.81 Aetna — MCR: $8.77 Aetna — OpenAccess: $7.81 Aetna — POS: $7.81 Aetna — PPO: $7.81 Aetna — QualifiedHealthPlan: $7.81 Aetna Better Health of Georgia — MCD: $9.11 BCBS — HIX: $8.12 BCBS — HMO: $9.55 BCBS — MCR: $8.94
Kidney function panel CPT 80069 · Outpatient (no overnight stay) In the file: RENAL FUNCTION PANEL	$1,618.25	$1,618.25	$216.85 – $1,456.42
Kidney function panel: 10 of 24 insurance plan rates Aetna — NAP: $892.14 American Steel Products — COMM: $1,375.51 Americas 1st Choice — MCR: $453.11 Amerigroup — MCD: $216.85 Centurion — PRISN: $448.09 City of Eastman — COMM: $1,375.51 Dodge Co Board of Commissioners — COMM: $1,375.51 Dodge County Hospital — COMM: $809.13 Graham Brothers Construction — COMM: $1,375.51 Leavitt Risk Partners — COMM: $485.48
Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Bilirubin, direct (82248) Phosphatase	$1,267.50	$1,267.50	$8.17 – $9.64
Liver function panel: 10 of 39 insurance plan rates Aetna — HMO: $7.35 Aetna — MCR: $8.25 Aetna — OpenAccess: $7.35 Aetna — POS: $7.35 Aetna — PPO: $7.35 Aetna — QualifiedHealthPlan: $7.35 Aetna Better Health of Georgia — MCD: $8.58 BCBS — HIX: $7.64 BCBS — HMO: $8.99 BCBS — MCR: $8.42
Liver function panel CPT 80076 · Outpatient (no overnight stay) In the file: HEPATIC FUNCTION PANEL	$1,267.50	$1,267.50	$169.84 – $1,140.75
Liver function panel: 10 of 24 insurance plan rates Aetna — NAP: $698.77 American Steel Products — COMM: $1,077.38 Americas 1st Choice — MCR: $354.90 Amerigroup — MCD: $169.84 Centurion — PRISN: $350.97 City of Eastman — COMM: $1,077.38 Dodge Co Board of Commissioners — COMM: $1,077.38 Dodge County Hospital — COMM: $633.75 Graham Brothers Construction — COMM: $1,077.38 Leavitt Risk Partners — COMM: $380.25
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity,	$558.25	$558.25	$2.96 – $3.74
Urine test (automated, with microscope): 10 of 39 insurance plan rates Aetna — HMO: $2.85 Aetna — MCR: $3.20 Aetna — OpenAccess: $2.85 Aetna — POS: $2.85 Aetna — PPO: $2.85 Aetna — QualifiedHealthPlan: $2.85 Aetna Better Health of Georgia — MCD: $3.33 BCBS — HIX: $2.96 BCBS — HMO: $3.49 BCBS — MCR: $3.27
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) In the file: UA W MICRO AUTO	$558.25	$558.25	$74.81 – $502.43
Urine test (automated, with microscope): 10 of 24 insurance plan rates Aetna — NAP: $307.76 American Steel Products — COMM: $474.51 Americas 1st Choice — MCR: $156.31 Amerigroup — MCD: $74.81 Centurion — PRISN: $154.58 City of Eastman — COMM: $474.51 Dodge Co Board of Commissioners — COMM: $474.51 Dodge County Hospital — COMM: $279.13 Graham Brothers Construction — COMM: $474.51 Leavitt Risk Partners — COMM: $167.47
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity,	$252	$252	$3.48 – $4.11
Urine test (manual, without microscope): 10 of 39 insurance plan rates Aetna — HMO: $3.13 Aetna — MCR: $3.51 Aetna — OpenAccess: $3.13 Aetna — POS: $3.13 Aetna — PPO: $3.13 Aetna — QualifiedHealthPlan: $3.13 Aetna Better Health of Georgia — MCD: $3.65 BCBS — HIX: $3.25 BCBS — HMO: $3.83 BCBS — MCR: $3.58
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) In the file: ACETONE UA MANUAL	$252	$252	$33.77 – $226.80
Urine test (manual, without microscope): 10 of 24 insurance plan rates Aetna — NAP: $138.93 American Steel Products — COMM: $214.20 Americas 1st Choice — MCR: $70.56 Amerigroup — MCD: $33.77 Centurion — PRISN: $69.78 City of Eastman — COMM: $214.20 Dodge Co Board of Commissioners — COMM: $214.20 Dodge County Hospital — COMM: $126 Graham Brothers Construction — COMM: $214.20 Leavitt Risk Partners — COMM: $75.60
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity,	$415.50	$415.50	$2.10 – $2.65
Urine test (automated, without microscope): 10 of 39 insurance plan rates Aetna — HMO: $2.03 Aetna — MCR: $2.27 Aetna — OpenAccess: $2.03 Aetna — POS: $2.03 Aetna — PPO: $2.03 Aetna — QualifiedHealthPlan: $2.03 Aetna Better Health of Georgia — MCD: $2.36 BCBS — HIX: $2.10 BCBS — HMO: $2.48 BCBS — MCR: $2.32
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) In the file: UA W O MICRO AUTO	$415.50	$415.50	$55.68 – $373.95
Urine test (automated, without microscope): 10 of 24 insurance plan rates Aetna — NAP: $229.07 American Steel Products — COMM: $353.18 Americas 1st Choice — MCR: $116.34 Amerigroup — MCD: $55.68 Centurion — PRISN: $115.05 City of Eastman — COMM: $353.18 Dodge Co Board of Commissioners — COMM: $353.18 Dodge County Hospital — COMM: $207.75 Graham Brothers Construction — COMM: $353.18 Leavitt Risk Partners — COMM: $124.65
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: PROS SPEC AG (PSA) TOTAL	$1,248.50	$1,248.50	$167.30 – $1,123.65
PSA (prostate specific antigen) blood test: 10 of 24 insurance plan rates Aetna — NAP: $688.30 American Steel Products — COMM: $1,061.22 Americas 1st Choice — MCR: $349.58 Amerigroup — MCD: $167.30 Centurion — PRISN: $345.71 City of Eastman — COMM: $1,061.22 Dodge Co Board of Commissioners — COMM: $1,061.22 Dodge County Hospital — COMM: $624.25 Graham Brothers Construction — COMM: $1,061.22 Leavitt Risk Partners — COMM: $374.55
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) In the file: Prostate specific antigen (PSA); total	Not listed in the file	Not listed in the file	$15.74 – $32.02
PSA (prostate specific antigen) blood test: 10 of 39 insurance plan rates Aetna — HMO: $16.55 Aetna — MCR: $18.57 Aetna — OpenAccess: $16.55 Aetna — POS: $16.55 Aetna — PPO: $16.55 Aetna — QualifiedHealthPlan: $16.55 Aetna Better Health of Georgia — MCD: $19.31 BCBS — HIX: $17.19 BCBS — HMO: $20.23 BCBS — MCR: $18.94
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: Thyroid stimulating hormone (TSH)	$846.25	$846.25	$16.80 – $19.82
Thyroid stimulating hormone (TSH) test: 10 of 39 insurance plan rates Aetna — HMO: $15.12 Aetna — MCR: $16.97 Aetna — OpenAccess: $15.12 Aetna — POS: $15.12 Aetna — PPO: $15.12 Aetna — QualifiedHealthPlan: $15.12 Aetna Better Health of Georgia — MCD: $17.64 BCBS — HIX: $15.71 BCBS — HMO: $18.48 BCBS — MCR: $17.30
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) In the file: TSH	$846.25	$846.25	$113.40 – $761.63
Thyroid stimulating hormone (TSH) test: 10 of 24 insurance plan rates Aetna — NAP: $466.54 American Steel Products — COMM: $719.31 Americas 1st Choice — MCR: $236.95 Amerigroup — MCD: $113.40 Centurion — PRISN: $234.33 City of Eastman — COMM: $719.31 Dodge Co Board of Commissioners — COMM: $719.31 Dodge County Hospital — COMM: $423.13 Graham Brothers Construction — COMM: $719.31 Leavitt Risk Partners — COMM: $253.88
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) In the file: Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count	Not listed in the file	Not listed in the file	$7.77 – $9.17
Complete blood count (CBC) with differential: 10 of 39 insurance plan rates Aetna — HMO: $6.99 Aetna — MCR: $7.85 Aetna — OpenAccess: $6.99 Aetna — POS: $6.99 Aetna — PPO: $6.99 Aetna — QualifiedHealthPlan: $6.99 Aetna Better Health of Georgia — MCD: $8.16 BCBS — HIX: $7.26 BCBS — HMO: $8.55 BCBS — MCR: $8
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count)	$711	$711	$6.05 – $7.63
Complete blood count (CBC), automated: 10 of 39 insurance plan rates Aetna — HMO: $5.82 Aetna — MCR: $6.53 Aetna — OpenAccess: $5.82 Aetna — POS: $5.82 Aetna — PPO: $5.82 Aetna — QualifiedHealthPlan: $5.82 Aetna Better Health of Georgia — MCD: $6.79 BCBS — HIX: $6.05 BCBS — HMO: $7.12 BCBS — MCR: $6.66
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) In the file: CBC AUTOMATED	$711	$711	$95.27 – $639.90
Complete blood count (CBC), automated: 10 of 24 insurance plan rates Aetna — NAP: $391.97 American Steel Products — COMM: $604.35 Americas 1st Choice — MCR: $199.08 Amerigroup — MCD: $95.27 Centurion — PRISN: $196.88 City of Eastman — COMM: $604.35 Dodge Co Board of Commissioners — COMM: $604.35 Dodge County Hospital — COMM: $355.50 Graham Brothers Construction — COMM: $604.35 Leavitt Risk Partners — COMM: $213.30
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: Prothrombin time;	$486	$486	$4.01 – $5.06
Blood clotting time test (prothrombin time, PT): 10 of 39 insurance plan rates Aetna — HMO: $3.86 Aetna — MCR: $4.33 Aetna — OpenAccess: $3.86 Aetna — POS: $3.86 Aetna — PPO: $3.86 Aetna — QualifiedHealthPlan: $3.86 Aetna Better Health of Georgia — MCD: $4.50 BCBS — HIX: $4.01 BCBS — HMO: $4.72 BCBS — MCR: $4.42
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) In the file: PROTIME	$486	$486	$65.12 – $437.40
Blood clotting time test (prothrombin time, PT): 10 of 24 insurance plan rates Aetna — NAP: $267.93 American Steel Products — COMM: $413.10 Americas 1st Choice — MCR: $136.08 Amerigroup — MCD: $65.12 Centurion — PRISN: $134.57 City of Eastman — COMM: $413.10 Dodge Co Board of Commissioners — COMM: $413.10 Dodge County Hospital — COMM: $243 Graham Brothers Construction — COMM: $413.10 Leavitt Risk Partners — COMM: $145.80
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: Thromboplastin time, partial (PTT); plasma or whole blood	$609.50	$609.50	$6.01 – $7.09
Blood clotting test (partial thromboplastin time, PTT): 10 of 39 insurance plan rates Aetna — HMO: $5.41 Aetna — MCR: $6.07 Aetna — OpenAccess: $5.41 Aetna — POS: $5.41 Aetna — PPO: $5.41 Aetna — QualifiedHealthPlan: $5.41 Aetna Better Health of Georgia — MCD: $6.31 BCBS — HIX: $5.62 BCBS — HMO: $6.61 BCBS — MCR: $6.19
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) In the file: PTT	$609.50	$609.50	$81.67 – $548.55
Blood clotting test (partial thromboplastin time, PTT): 10 of 24 insurance plan rates Aetna — NAP: $336.02 American Steel Products — COMM: $518.08 Americas 1st Choice — MCR: $170.66 Amerigroup — MCD: $81.67 Centurion — PRISN: $168.77 City of Eastman — COMM: $518.08 Dodge Co Board of Commissioners — COMM: $518.08 Dodge County Hospital — COMM: $304.75 Graham Brothers Construction — COMM: $518.08 Leavitt Risk Partners — COMM: $182.85

Imaging (X-ray, CT, MRI, ultrasound, mammogram)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) In the file: CT HEAD/BRAIN W/O CONT	$8,042	$8,042	$1,077.63 – $7,237.80
CT scan of the head or brain, without contrast: 10 of 19 insurance plan rates Aetna — NAP: $4,433.55 American Steel Products — COMM: $6,835.70 Americas 1st Choice — MCR: $2,251.76 Amerigroup — MCD: $1,077.63 City of Eastman — COMM: $6,835.70 Dodge Co Board of Commissioners — COMM: $6,835.70 Dodge County Hospital — COMM: $4,021 Graham Brothers Construction — COMM: $6,835.70 Leavitt Risk Partners — COMM: $2,412.60 Memorial Health Plan — EMPLOYEEPLAN: $1,769.24
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) In the file: Computed tomography, head or brain; without contrast material	Not listed in the file	Not listed in the file	$125.48 – $180.57
CT scan of the head or brain, without contrast: 10 of 13 insurance plan rates Aetna — HMO: $137.05 Aetna — OpenAccess: $137.05 Aetna — POS: $137.05 Aetna — PPO: $137.05 Aetna — QualifiedHealthPlan: $137.05 BCBS — HIX: $148.48 BCBS — HMO: $168.43 BCBS — Pathway: $148.48 BCBS — PPO: $180.57 Core Resources — COMM: $141.12
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · modifier TC In the file: Computed tomography, head or brain; without contrast material	Not listed in the file	Not listed in the file	$95.12 – $115.68
CT scan of the head or brain, without contrast: rates for 9 insurance plans BCBS — HIX: $95.12 BCBS — HMO: $107.90 BCBS — Pathway: $95.12 BCBS — PPO: $115.68 Employer's Health Network — WCOMP: $272.99 Identity MCO — WorkersComp: $278.56 Prime Health — WORKERSCOMP: $267.42 Rockport United Network — WORKERSCOMP: $272.99 Synergy Health Network — WorkersComp: $278.56
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: MRI BRAIN W&WO CONT	$13,388	$13,388	$1,793.99 – $12,049.20
MRI of the brain, before and after contrast: 10 of 19 insurance plan rates Aetna — NAP: $7,380.80 American Steel Products — COMM: $11,379.80 Americas 1st Choice — MCR: $3,748.64 Amerigroup — MCD: $1,793.99 City of Eastman — COMM: $11,379.80 Dodge Co Board of Commissioners — COMM: $11,379.80 Dodge County Hospital — COMM: $6,694 Graham Brothers Construction — COMM: $11,379.80 Leavitt Risk Partners — COMM: $4,016.40 Memorial Health Plan — EMPLOYEEPLAN: $2,945.36
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) In the file: Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and furth	Not listed in the file	Not listed in the file	$421.41 – $828.27
MRI of the brain, before and after contrast: 10 of 13 insurance plan rates Aetna — HMO: $460.68 Aetna — OpenAccess: $460.68 Aetna — POS: $460.68 Aetna — PPO: $460.68 Aetna — QualifiedHealthPlan: $460.68 BCBS — HIX: $442.50 BCBS — HMO: $501.97 BCBS — Pathway: $442.50 BCBS — PPO: $538.14 Core Resources — COMM: $508.54
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · modifier TC In the file: Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and furth	Not listed in the file	Not listed in the file	$300.03 – $364.89
MRI of the brain, before and after contrast: rates for 9 insurance plans BCBS — HIX: $300.03 BCBS — HMO: $340.36 BCBS — Pathway: $300.03 BCBS — PPO: $364.89 Employer's Health Network — WCOMP: $916.79 Identity MCO — WorkersComp: $935.50 Prime Health — WORKERSCOMP: $898.08 Rockport United Network — WORKERSCOMP: $916.79 Synergy Health Network — WorkersComp: $935.50
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: CHEST XRAY 2 V	$1,552.75	$1,552.75	$208.07 – $1,397.47
Chest X-ray, 2 views: 10 of 25 insurance plan rates Aetna — NAP: $856.03 American Steel Products — COMM: $1,319.84 Americas 1st Choice — MCR: $434.77 Amerigroup — MCD: $208.07 Centurion — PRISN: $429.96 City of Eastman — COMM: $1,319.84 Dodge Co Board of Commissioners — COMM: $1,319.84 Dodge County Hospital — COMM: $776.38 Graham Brothers Construction — COMM: $1,319.84 Health One Alliance — COMMHIX: $698.74
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) In the file: Radiologic examination, chest; 2 views	Not listed in the file	Not listed in the file	$37.50 – $103.90
Chest X-ray, 2 views: 10 of 13 insurance plan rates Aetna — HMO: $43.13 Aetna — OpenAccess: $43.13 Aetna — POS: $43.13 Aetna — PPO: $43.13 Aetna — QualifiedHealthPlan: $43.13 BCBS — HIX: $46.17 BCBS — HMO: $52.38 BCBS — Pathway: $46.17 BCBS — PPO: $56.15 Core Resources — COMM: $37.50
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · modifier TC In the file: Radiologic examination, chest; 2 views	Not listed in the file	Not listed in the file	$32.57 – $39.61
Chest X-ray, 2 views: rates for 9 insurance plans BCBS — HIX: $32.57 BCBS — HMO: $36.95 BCBS — Pathway: $32.57 BCBS — PPO: $39.61 Employer's Health Network — WCOMP: $226.04 Identity MCO — WorkersComp: $230.65 Prime Health — WORKERSCOMP: $221.42 Rockport United Network — WORKERSCOMP: $226.04 Synergy Health Network — WorkersComp: $230.65
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: XR L-SPINE 4 + VIEWS	$2,815	$2,815	$377.21 – $2,533.50
X-ray of the lower spine, at least 4 views: 10 of 24 insurance plan rates Aetna — NAP: $1,551.91 American Steel Products — COMM: $2,392.75 Americas 1st Choice — MCR: $788.20 Amerigroup — MCD: $377.21 Centurion — PRISN: $779.47 City of Eastman — COMM: $2,392.75 Dodge Co Board of Commissioners — COMM: $2,392.75 Dodge County Hospital — COMM: $1,407.50 Graham Brothers Construction — COMM: $2,392.75 Leavitt Risk Partners — COMM: $844.50
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) In the file: Radiologic examination, spine, lumbosacral; minimum of 4 views	Not listed in the file	Not listed in the file	$125.48
X-ray of the lower spine, at least 4 views: 10 of 13 insurance plan rates Aetna — HMO: $71.44 Aetna — OpenAccess: $71.44 Aetna — POS: $71.44 Aetna — PPO: $71.44 Aetna — QualifiedHealthPlan: $71.44 BCBS — HIX: $74.85 BCBS — HMO: $84.91 BCBS — Pathway: $74.85 BCBS — PPO: $91.03 Core Resources — COMM: $63.41
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · modifier TC In the file: Radiologic examination, spine, lumbosacral; minimum of 4 views	Not listed in the file	Not listed in the file	$57.68 – $70.15
X-ray of the lower spine, at least 4 views: rates for 9 insurance plans BCBS — HIX: $57.68 BCBS — HMO: $65.43 BCBS — Pathway: $57.68 BCBS — PPO: $70.15 Employer's Health Network — WCOMP: $272.99 Identity MCO — WorkersComp: $278.56 Prime Health — WORKERSCOMP: $267.42 Rockport United Network — WORKERSCOMP: $272.99 Synergy Health Network — WorkersComp: $278.56
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: MRI L-SPINE W/O CONT	$10,411	$10,411	$1,395.07 – $9,369.90
MRI of the lower back (lumbar spine), without contrast: 10 of 19 insurance plan rates Aetna — NAP: $5,739.58 American Steel Products — COMM: $8,849.35 Americas 1st Choice — MCR: $2,915.08 Amerigroup — MCD: $1,395.07 City of Eastman — COMM: $8,849.35 Dodge Co Board of Commissioners — COMM: $8,849.35 Dodge County Hospital — COMM: $5,205.50 Graham Brothers Construction — COMM: $8,849.35 Leavitt Risk Partners — COMM: $3,123.30 Memorial Health Plan — EMPLOYEEPLAN: $2,290.42
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) In the file: Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material	Not listed in the file	Not listed in the file	$285.23 – $517.79
MRI of the lower back (lumbar spine), without contrast: 10 of 13 insurance plan rates Aetna — HMO: $264.43 Aetna — OpenAccess: $264.43 Aetna — POS: $264.43 Aetna — PPO: $264.43 Aetna — QualifiedHealthPlan: $264.43 BCBS — HIX: $267.39 BCBS — HMO: $303.33 BCBS — Pathway: $267.39 BCBS — PPO: $325.19 Core Resources — COMM: $289.71
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · modifier TC In the file: Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material	Not listed in the file	Not listed in the file	$607.86 – $633.19
MRI of the lower back (lumbar spine), without contrast: rates for 9 insurance plans BCBS — HIX: $174.60 BCBS — HMO: $198.06 BCBS — Pathway: $174.60 BCBS — PPO: $212.34 Employer's Health Network — WCOMP: $620.53 Identity MCO — WorkersComp: $633.19 Prime Health — WORKERSCOMP: $607.86 Rockport United Network — WORKERSCOMP: $620.53 Synergy Health Network — WorkersComp: $633.19
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: CT PELVIS W/CONTRAST	$7,301	$7,301	$978.33 – $6,570.90
CT scan of the pelvis, with contrast: 10 of 19 insurance plan rates Aetna — NAP: $4,025.04 American Steel Products — COMM: $6,205.85 Americas 1st Choice — MCR: $2,044.28 Amerigroup — MCD: $978.33 City of Eastman — COMM: $6,205.85 Dodge Co Board of Commissioners — COMM: $6,205.85 Dodge County Hospital — COMM: $3,650.50 Graham Brothers Construction — COMM: $6,205.85 Leavitt Risk Partners — COMM: $2,190.30 Memorial Health Plan — EMPLOYEEPLAN: $1,606.22
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) In the file: Computed tomography, pelvis; with contrast material(s)	Not listed in the file	Not listed in the file	$210.06 – $401.74
CT scan of the pelvis, with contrast: 10 of 13 insurance plan rates Aetna — HMO: $362.88 Aetna — OpenAccess: $362.88 Aetna — POS: $362.88 Aetna — PPO: $362.88 Aetna — QualifiedHealthPlan: $362.88 BCBS — HIX: $316.57 BCBS — HMO: $359.11 BCBS — Pathway: $316.57 BCBS — PPO: $384.99 Core Resources — COMM: $322.43
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · modifier TC In the file: Computed tomography, pelvis; with contrast material(s)	Not listed in the file	Not listed in the file	$244.25 – $297.04
CT scan of the pelvis, with contrast: rates for 9 insurance plans BCBS — HIX: $244.25 BCBS — HMO: $277.07 BCBS — Pathway: $244.25 BCBS — PPO: $297.04 Employer's Health Network — WCOMP: $456.99 Identity MCO — WorkersComp: $466.32 Prime Health — WORKERSCOMP: $447.67 Rockport United Network — WORKERSCOMP: $456.99 Synergy Health Network — WorkersComp: $466.32
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) In the file: Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material	Not listed in the file	Not listed in the file	$285.23 – $517.79
MRI of a leg joint (such as the knee), without contrast: 10 of 13 insurance plan rates Aetna — HMO: $297.91 Aetna — OpenAccess: $297.91 Aetna — POS: $297.91 Aetna — PPO: $297.91 Aetna — QualifiedHealthPlan: $297.91 BCBS — HIX: $285.79 BCBS — HMO: $324.20 BCBS — Pathway: $285.79 BCBS — PPO: $347.57 Core Resources — COMM: $326.54
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · modifier RT In the file: MRI LW JNT W/O CONT RT	$9,391	$9,391	$1,258.39 – $8,451.90
MRI of a leg joint (such as the knee), without contrast: 10 of 19 insurance plan rates Aetna — NAP: $5,177.26 American Steel Products — COMM: $7,982.35 Americas 1st Choice — MCR: $2,629.48 Amerigroup — MCD: $1,258.39 City of Eastman — COMM: $7,982.35 Dodge Co Board of Commissioners — COMM: $7,982.35 Dodge County Hospital — COMM: $4,695.50 Graham Brothers Construction — COMM: $7,982.35 Leavitt Risk Partners — COMM: $2,817.30 Memorial Health Plan — EMPLOYEEPLAN: $2,066.02
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · modifier 50 In the file: MRI LW JNT W/O CONT BI	$15,966	$15,966	$2,139.44 – $14,369.40
MRI of a leg joint (such as the knee), without contrast: 10 of 19 insurance plan rates Aetna — NAP: $8,802.06 American Steel Products — COMM: $13,571.10 Americas 1st Choice — MCR: $4,470.48 Amerigroup — MCD: $2,139.44 City of Eastman — COMM: $13,571.10 Dodge Co Board of Commissioners — COMM: $13,571.10 Dodge County Hospital — COMM: $7,983 Graham Brothers Construction — COMM: $13,571.10 Leavitt Risk Partners — COMM: $4,789.80 Memorial Health Plan — EMPLOYEEPLAN: $3,512.52
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: CT ABD&PELVIS W/CONT	$15,781	$15,781	$2,114.65 – $14,202.90
CT scan of the abdomen and pelvis, with contrast: 10 of 19 insurance plan rates Aetna — NAP: $8,700.07 American Steel Products — COMM: $13,413.85 Americas 1st Choice — MCR: $4,418.68 Amerigroup — MCD: $2,114.65 City of Eastman — COMM: $13,413.85 Dodge Co Board of Commissioners — COMM: $13,413.85 Dodge County Hospital — COMM: $7,890.50 Graham Brothers Construction — COMM: $13,413.85 Leavitt Risk Partners — COMM: $4,734.30 Memorial Health Plan — EMPLOYEEPLAN: $3,471.82
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) In the file: Computed tomography, abdomen and pelvis; with contrast material(s)	Not listed in the file	Not listed in the file	$420.24 – $511.08
CT scan of the abdomen and pelvis, with contrast: 10 of 13 insurance plan rates Aetna — HMO: $460.05 Aetna — OpenAccess: $460.05 Aetna — POS: $460.05 Aetna — PPO: $460.05 Aetna — QualifiedHealthPlan: $460.05 BCBS — HIX: $420.24 BCBS — HMO: $476.72 BCBS — Pathway: $420.24 BCBS — PPO: $511.08 Core Resources — COMM: $424.01
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · modifier TC In the file: Computed tomography, abdomen and pelvis; with contrast material(s)	Not listed in the file	Not listed in the file	$306.79 – $373.11
CT scan of the abdomen and pelvis, with contrast: rates for 9 insurance plans BCBS — HIX: $306.79 BCBS — HMO: $348.03 BCBS — Pathway: $306.79 BCBS — PPO: $373.11 Employer's Health Network — WCOMP: $916.79 Identity MCO — WorkersComp: $935.50 Prime Health — WORKERSCOMP: $898.08 Rockport United Network — WORKERSCOMP: $916.79 Synergy Health Network — WorkersComp: $935.50
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: US ABDOMEN COMPLETE	$5,525.75	$5,525.75	$740.45 – $4,973.18
Ultrasound of the abdomen, complete: 10 of 24 insurance plan rates Aetna — NAP: $3,046.35 American Steel Products — COMM: $4,696.89 Americas 1st Choice — MCR: $1,547.21 Amerigroup — MCD: $740.45 Centurion — PRISN: $1,530.08 City of Eastman — COMM: $4,696.89 Dodge Co Board of Commissioners — COMM: $4,696.89 Dodge County Hospital — COMM: $2,762.88 Graham Brothers Construction — COMM: $4,696.89 Leavitt Risk Partners — COMM: $1,657.72
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) In the file: Ultrasound, abdominal, real time with image documentation; complete	Not listed in the file	Not listed in the file	$125.48
Ultrasound of the abdomen, complete: 10 of 13 insurance plan rates Aetna — HMO: $156.35 Aetna — OpenAccess: $156.35 Aetna — POS: $156.35 Aetna — PPO: $156.35 Aetna — QualifiedHealthPlan: $156.35 BCBS — HIX: $159.46 BCBS — HMO: $180.89 BCBS — Pathway: $159.46 BCBS — PPO: $193.93 Core Resources — COMM: $159.51
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · modifier TC In the file: Ultrasound, abdominal, real time with image documentation; complete	Not listed in the file	Not listed in the file	$267.42 – $278.56
Ultrasound of the abdomen, complete: rates for 9 insurance plans BCBS — HIX: $108.73 BCBS — HMO: $123.34 BCBS — Pathway: $108.73 BCBS — PPO: $132.23 Employer's Health Network — WCOMP: $272.99 Identity MCO — WorkersComp: $278.56 Prime Health — WORKERSCOMP: $267.42 Rockport United Network — WORKERSCOMP: $272.99 Synergy Health Network — WorkersComp: $278.56
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: US PREG AFTER 1ST TRI	$3,375.75	$3,375.75	$452.35 – $3,038.18
Pregnancy ultrasound (after the first trimester): 10 of 24 insurance plan rates Aetna — NAP: $1,861.05 American Steel Products — COMM: $2,869.39 Americas 1st Choice — MCR: $945.21 Amerigroup — MCD: $452.35 Centurion — PRISN: $934.75 City of Eastman — COMM: $2,869.39 Dodge Co Board of Commissioners — COMM: $2,869.39 Dodge County Hospital — COMM: $1,687.88 Graham Brothers Construction — COMM: $2,869.39 Leavitt Risk Partners — COMM: $1,012.73
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) In the file: Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 day	Not listed in the file	Not listed in the file	$125.48
Pregnancy ultrasound (after the first trimester): 10 of 13 insurance plan rates Aetna — HMO: $173.73 Aetna — OpenAccess: $173.73 Aetna — POS: $173.73 Aetna — PPO: $173.73 Aetna — QualifiedHealthPlan: $173.73 BCBS — HIX: $189.73 BCBS — HMO: $215.23 BCBS — Pathway: $189.73 BCBS — PPO: $230.74 Core Resources — COMM: $178.62
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · modifier TC In the file: Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 day	Not listed in the file	Not listed in the file	$267.42 – $278.56
Pregnancy ultrasound (after the first trimester): rates for 9 insurance plans BCBS — HIX: $125.78 BCBS — HMO: $142.69 BCBS — Pathway: $125.78 BCBS — PPO: $152.97 Employer's Health Network — WCOMP: $272.99 Identity MCO — WorkersComp: $278.56 Prime Health — WORKERSCOMP: $267.42 Rockport United Network — WORKERSCOMP: $272.99 Synergy Health Network — WorkersComp: $278.56
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: US TRANSVAGINAL	$3,991.75	$3,991.75	$534.89 – $3,592.57
Transvaginal ultrasound: 10 of 24 insurance plan rates Aetna — NAP: $2,200.65 American Steel Products — COMM: $3,392.99 Americas 1st Choice — MCR: $1,117.69 Amerigroup — MCD: $534.89 Centurion — PRISN: $1,105.32 City of Eastman — COMM: $3,392.99 Dodge Co Board of Commissioners — COMM: $3,392.99 Dodge County Hospital — COMM: $1,995.88 Graham Brothers Construction — COMM: $3,392.99 Leavitt Risk Partners — COMM: $1,197.53
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) In the file: Ultrasound, transvaginal	Not listed in the file	Not listed in the file	$125.48
Transvaginal ultrasound: 10 of 13 insurance plan rates Aetna — HMO: $171.15 Aetna — OpenAccess: $171.15 Aetna — POS: $171.15 Aetna — PPO: $171.15 Aetna — QualifiedHealthPlan: $171.15 BCBS — HIX: $164.48 BCBS — HMO: $186.58 BCBS — Pathway: $164.48 BCBS — PPO: $200.03 Core Resources — COMM: $169.74
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · modifier TC In the file: Ultrasound, transvaginal	Not listed in the file	Not listed in the file	$120.57 – $146.63
Transvaginal ultrasound: rates for 9 insurance plans BCBS — HIX: $120.57 BCBS — HMO: $136.78 BCBS — Pathway: $120.57 BCBS — PPO: $146.63 Employer's Health Network — WCOMP: $272.99 Identity MCO — WorkersComp: $278.56 Prime Health — WORKERSCOMP: $267.42 Rockport United Network — WORKERSCOMP: $272.99 Synergy Health Network — WorkersComp: $278.56
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) In the file: Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral	Not listed in the file	Not listed in the file	$173.21 – $210.65
Diagnostic mammogram, one breast: 10 of 32 insurance plan rates Aetna — HMO: $168.59 Aetna — MCR: $77.74 Aetna — OpenAccess: $168.59 Aetna — POS: $168.59 Aetna — PPO: $168.59 Aetna — QualifiedHealthPlan: $168.59 BCBS — HIX: $173.21 BCBS — HMO: $196.49 BCBS — MCR: $79.28 BCBS — Pathway: $173.21
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · modifier RT In the file: MAMMO DIAG CAD UNI RT	$716.25	$716.25	$95.98 – $644.63
Diagnostic mammogram, one breast: 10 of 25 insurance plan rates Aetna — NAP: $394.87 American Steel Products — COMM: $608.81 Americas 1st Choice — MCR: $200.55 Amerigroup — MCD: $95.98 Centurion — PRISN: $198.33 City of Eastman — COMM: $608.81 Dodge Co Board of Commissioners — COMM: $608.81 Dodge County Hospital — COMM: $358.13 Graham Brothers Construction — COMM: $608.81 Leavitt Risk Partners — COMM: $214.88
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · modifier LT In the file: MAMMO DIAG CAD UNI LT	$716.25	$716.25	$95.98 – $644.63
Diagnostic mammogram, one breast: 10 of 25 insurance plan rates Aetna — NAP: $394.87 American Steel Products — COMM: $608.81 Americas 1st Choice — MCR: $200.55 Amerigroup — MCD: $95.98 Centurion — PRISN: $198.33 City of Eastman — COMM: $608.81 Dodge Co Board of Commissioners — COMM: $608.81 Dodge County Hospital — COMM: $358.13 Graham Brothers Construction — COMM: $608.81 Leavitt Risk Partners — COMM: $214.88
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: MAMMO DIAG CAD BI	$877.75	$877.75	$117.62 – $789.98
Diagnostic mammogram, both breasts: 10 of 25 insurance plan rates Aetna — NAP: $483.90 American Steel Products — COMM: $746.09 Americas 1st Choice — MCR: $245.77 Amerigroup — MCD: $117.62 Centurion — PRISN: $243.05 City of Eastman — COMM: $746.09 Dodge Co Board of Commissioners — COMM: $746.09 Dodge County Hospital — COMM: $438.88 Graham Brothers Construction — COMM: $746.09 Leavitt Risk Partners — COMM: $263.32
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) In the file: Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral	Not listed in the file	Not listed in the file	$219.42 – $266.85
Diagnostic mammogram, both breasts: 10 of 32 insurance plan rates Aetna — HMO: $215.54 Aetna — MCR: $99.81 Aetna — OpenAccess: $215.54 Aetna — POS: $215.54 Aetna — PPO: $215.54 Aetna — QualifiedHealthPlan: $215.54 BCBS — HIX: $219.42 BCBS — HMO: $248.91 BCBS — MCR: $101.78 BCBS — Pathway: $219.42
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · modifier TC In the file: Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral	Not listed in the file	Not listed in the file	$156.58 – $190.43
Diagnostic mammogram, both breasts: rates for 4 insurance plans BCBS — HIX: $156.58 BCBS — HMO: $177.63 BCBS — Pathway: $156.58 BCBS — PPO: $190.43
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: MAMMO SCR CAD BI	$811	$811	$108.67 – $729.90
Screening mammogram, both breasts: 10 of 25 insurance plan rates Aetna — NAP: $447.10 American Steel Products — COMM: $689.35 Americas 1st Choice — MCR: $227.08 Amerigroup — MCD: $108.67 Centurion — PRISN: $224.57 City of Eastman — COMM: $689.35 Dodge Co Board of Commissioners — COMM: $689.35 Dodge County Hospital — COMM: $405.50 Graham Brothers Construction — COMM: $689.35 Leavitt Risk Partners — COMM: $243.30
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) In the file: Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when performed	Not listed in the file	Not listed in the file	$176.77 – $214.98
Screening mammogram, both breasts: 10 of 32 insurance plan rates Aetna — HMO: $178.23 Aetna — MCR: $82.25 Aetna — OpenAccess: $178.23 Aetna — POS: $178.23 Aetna — PPO: $178.23 Aetna — QualifiedHealthPlan: $178.23 BCBS — HIX: $176.77 BCBS — HMO: $200.53 BCBS — MCR: $83.88 BCBS — Pathway: $176.77
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · modifier 52 In the file: MAMMO SCR CAD 1BRST	$811	$811	$108.67 – $729.90
Screening mammogram, both breasts: 10 of 25 insurance plan rates Aetna — NAP: $447.10 American Steel Products — COMM: $689.35 Americas 1st Choice — MCR: $227.08 Amerigroup — MCD: $108.67 Centurion — PRISN: $224.57 City of Eastman — COMM: $689.35 Dodge Co Board of Commissioners — COMM: $689.35 Dodge County Hospital — COMM: $405.50 Graham Brothers Construction — COMM: $689.35 Leavitt Risk Partners — COMM: $243.30

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Electrocardiogram (ECG/EKG) with reading CPT 93000 · Outpatient (no overnight stay) In the file: Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report	Not listed in the file	Not listed in the file	$11.97
Electrocardiogram (ECG/EKG) with reading: rates for 7 insurance plans Humana — TRICARE: $11.97 Aetna — HMO: 34.4% (a percentage in the contract, not a dollar amount) Aetna — NAP: 55.13% (a percentage in the contract, not a dollar amount) Aetna — OpenAccess: 34.4% (a percentage in the contract, not a dollar amount) Aetna — POS: 34.4% (a percentage in the contract, not a dollar amount) Aetna — PPO: 34.4% (a percentage in the contract, not a dollar amount) Aetna — QualifiedHealthPlan: 25.86% (a percentage in the contract, not a dollar amount)
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) In the file: CATH HRT LT/INJ L VENT	$32,327	$32,327	$6,142.13 – $29,094.30
Left heart catheterization (diagnostic): 10 of 14 insurance plan rates Aetna — NAP: $17,821.88 American Steel Products — COMM: $27,477.95 Americas 1st Choice — MCR: $9,051.56 City of Eastman — COMM: $27,477.95 Dodge County Hospital — COMM: $16,163.50 Graham Brothers Construction — COMM: $27,477.95 Leavitt Risk Partners — COMM: $9,698.10 Memorial Health Plan — EMPLOYEEPLAN: $7,111.94 MultiPlan — Complementary: $29,094.30 MultiPlan — Primary: $29,094.30
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) In the file: Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when pe	Not listed in the file	Not listed in the file	$2,284 – $14,420
Left heart catheterization (diagnostic): 10 of 27 insurance plan rates Aetna — HMO: $10,351 Aetna — OpenAccess: $10,351 Aetna — POS: $10,351 Aetna — PPO: $10,351 Aetna — QualifiedHealthPlan: $7,394 Amerigroup — MCD: $2,950 BCBS — HIX: $7,786.25 BCBS — HMO: $8,832.65 BCBS — Pathway: $7,786.25 BCBS — PPO: $8,977.37
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · modifier 59 In the file: CATH HRT LT/INJ L VENT59	$32,327	$32,327	$6,142.13 – $29,094.30
Left heart catheterization (diagnostic): 10 of 14 insurance plan rates Aetna — NAP: $17,821.88 American Steel Products — COMM: $27,477.95 Americas 1st Choice — MCR: $9,051.56 City of Eastman — COMM: $27,477.95 Dodge County Hospital — COMM: $16,163.50 Graham Brothers Construction — COMM: $27,477.95 Leavitt Risk Partners — COMM: $9,698.10 Memorial Health Plan — EMPLOYEEPLAN: $7,111.94 MultiPlan — Complementary: $29,094.30 MultiPlan — Primary: $29,094.30
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) In the file: Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recor	$23,067	$23,067	$4,178 – $9,657
Heart rhythm study (electrophysiology evaluation): 10 of 27 insurance plan rates Aetna — HMO: $17,870 Aetna — OpenAccess: $17,870 Aetna — POS: $17,870 Aetna — PPO: $17,870 Aetna — QualifiedHealthPlan: $12,764 Americas 1st Choice — MCR: $8,300 Amerigroup — MCD: $1,850 BCBS — HIX: $7,705.53 BCBS — HMO: $8,741.08 BCBS — Pathway: $7,705.53
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) In the file: EP W/O ARRHYTHMIA	$23,067	$23,067	$4,382.73 – $20,760.30
Heart rhythm study (electrophysiology evaluation): 10 of 18 insurance plan rates Aetna — NAP: $12,716.84 American Steel Products — COMM: $19,606.95 City of Eastman — COMM: $19,606.95 Dodge County Hospital — COMM: $11,533.50 Graham Brothers Construction — COMM: $19,606.95 Leavitt Risk Partners — COMM: $6,920.10 Memorial Health Plan — COASTALHEALTHPLAN: $10,380.15 Memorial Health Plan — COMM: $8,534.79 Memorial Health Plan — CORECOMMUNITYCARE: $10,149.48 Memorial Health Plan — EMPLOYEEPLAN: $5,074.74
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · modifier TC In the file: Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recor	$23,067	$23,067	$10,977.83 – $11,435.24
Heart rhythm study (electrophysiology evaluation): rates for 5 insurance plans Employer's Health Network — WCOMP: $11,206.54 Identity MCO — WorkersComp: $11,435.24 Prime Health — WORKERSCOMP: $10,977.83 Rockport United Network — WORKERSCOMP: $11,206.54 Synergy Health Network — WorkersComp: $11,435.24
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) In the file: Comprehensive electrophysiologic evaluation with transseptal catheterizations, insertion and repositioning of multiple electrode catheters,	$110,804	$110,804	$4,178 – $11,135
Heart rhythm study with ablation for atrial fibrillation: 10 of 31 insurance plan rates Aetna — HMO: $17,870 Aetna — OpenAccess: $17,870 Aetna — POS: $17,870 Aetna — PPO: $17,870 Aetna — QualifiedHealthPlan: $12,764 Americas 1st Choice — MCR: $8,300 Amerigroup — MCD: $1,850 BCBS — HIX: $9,154.13 BCBS — HMO: $10,384.40 BCBS — Pathway: $9,154.13
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) In the file: COM EP REPO CTH TX AFIB	$110,804	$110,804	$21,052.76 – $99,723.60
Heart rhythm study with ablation for atrial fibrillation: 10 of 15 insurance plan rates Aetna — NAP: $61,086.25 American Steel Products — COMM: $94,183.40 City of Eastman — COMM: $94,183.40 Dodge County Hospital — COMM: $55,402 Graham Brothers Construction — COMM: $94,183.40 Health One Alliance — COMMHIX: $49,861.80 Leavitt Risk Partners — COMM: $33,241.20 Memorial Health Plan — EMPLOYEEPLAN: $24,376.88 MultiPlan — Complementary: $99,723.60 MultiPlan — Primary: $99,723.60
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) In the file: POLYSOMNOGRAPHY >4 PAR	$9,521	$9,521	$1,275.81 – $8,568.90
Sleep study (overnight, in a sleep lab): 10 of 31 insurance plan rates Aetna — NAP: $5,248.93 American Steel Products — COMM: $8,092.85 Americas 1st Choice — MCR: $2,665.88 Amerigroup — MCD: $1,275.81 Centurion — PRISN: $2,636.36 Cigna — HMO: $3,456.12 Cigna — LocalPlus: $2,589.71 Cigna — OAP: $3,456.12 Cigna — PPO: $3,456.12 City of Eastman — COMM: $8,092.85
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) In the file: Polysomnography; age 6 years or older, sleep staging with 4 or more additional parameters of sleep, attended by a technologist	Not listed in the file	Not listed in the file	$2,421 – $2,961.54
Sleep study (overnight, in a sleep lab): 10 of 11 insurance plan rates BCBS — HIX: $2,434.69 BCBS — HMO: $2,761.89 BCBS — Pathway: $2,434.69 BCBS — PPO: $2,961.54 Core Resources — COMM: $2,856.96 United — AllPayerAppendix: $2,421 Aetna — HMO: 34.4% (a percentage in the contract, not a dollar amount) Aetna — OpenAccess: 34.4% (a percentage in the contract, not a dollar amount) Aetna — POS: 34.4% (a percentage in the contract, not a dollar amount) Aetna — PPO: 34.4% (a percentage in the contract, not a dollar amount)
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · modifier 52 In the file: INCOMPLETE POL>4PAR	$4,762	$4,762	$638.11 – $4,285.80
Sleep study (overnight, in a sleep lab): 10 of 31 insurance plan rates Aetna — NAP: $2,625.29 American Steel Products — COMM: $4,047.70 Americas 1st Choice — MCR: $1,333.36 Amerigroup — MCD: $638.11 Centurion — PRISN: $1,318.60 Cigna — HMO: $1,728.61 Cigna — LocalPlus: $1,295.26 Cigna — OAP: $1,728.61 Cigna — PPO: $1,728.61 City of Eastman — COMM: $4,047.70

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) In the file: Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexib	Not listed in the file	Not listed in the file	$26.81 – $41.46
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 26 insurance plan rates Aetna — MCR: $27.92 BCBS — MCR: $28.47 Clover — MCR: $29.02 Coventry — MGMCR: $28.19 Devoted Health — MCR: $27.64 Eon Health — MCR: $29.02 Georgia Assurance — MCR: $29.02 Health Net — FED: $26.81 HealthSpring — MCRHMO: $27.92 HealthSpring — PFFS: $27.92
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · modifier GP\|CQ In the file: THER EXERCIS 15 MIN PTCQ	$470.25	$470.25	$63.01 – $423.23
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 31 insurance plan rates Aetna — NAP: $259.25 American Steel Products — COMM: $399.71 Americas 1st Choice — MCR: $131.67 Amerigroup — MCD: $63.01 Centurion — PRISN: $130.21 Cigna — HMO: $170.70 Cigna — LocalPlus: $127.91 Cigna — OAP: $170.70 Cigna — PPO: $170.70 City of Eastman — COMM: $399.71
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · modifier GO\|CO In the file: THER EXERCIS 15 MIN OTCO	$305	$305	$40.87 – $274.50
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 31 insurance plan rates Aetna — NAP: $168.15 American Steel Products — COMM: $259.25 Americas 1st Choice — MCR: $85.40 Amerigroup — MCD: $40.87 Centurion — PRISN: $84.45 Cigna — HMO: $110.72 Cigna — LocalPlus: $82.96 Cigna — OAP: $110.72 Cigna — PPO: $110.72 City of Eastman — COMM: $259.25
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) In the file: Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact	Not listed in the file	Not listed in the file	$90.16 – $139.43
Physical therapy evaluation (low complexity): 10 of 26 insurance plan rates Aetna — MCR: $93.88 BCBS — MCR: $95.74 Clover — MCR: $97.60 Coventry — MGMCR: $94.81 Devoted Health — MCR: $92.95 Eon Health — MCR: $97.60 Georgia Assurance — MCR: $97.60 Health Net — FED: $90.16 HealthSpring — MCRHMO: $93.88 HealthSpring — PFFS: $93.88
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · modifier GP In the file: EVAL PT LOW COMPLEX	$1,293.50	$1,293.50	$173.33 – $1,164.15
Physical therapy evaluation (low complexity): 10 of 31 insurance plan rates Aetna — NAP: $713.11 American Steel Products — COMM: $1,099.47 Americas 1st Choice — MCR: $362.18 Amerigroup — MCD: $173.33 Centurion — PRISN: $358.17 Cigna — HMO: $469.54 Cigna — LocalPlus: $351.83 Cigna — OAP: $469.54 Cigna — PPO: $469.54 City of Eastman — COMM: $1,099.47
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · modifier GP\|CQ In the file: Physical therapy evaluation: low complexity, requiring these components: A history with no personal factors and/or comorbidities that impact	Not listed in the file	Not listed in the file	$79.34 – $122.69
Physical therapy evaluation (low complexity): 10 of 20 insurance plan rates Aetna — MCR: $82.61 BCBS — MCR: $84.25 Clover — MCR: $85.89 Coventry — MGMCR: $83.43 Devoted Health — MCR: $81.80 Eon Health — MCR: $85.89 Georgia Assurance — MCR: $85.89 Health Net — FED: $79.34 HealthSpring — MCRHMO: $82.61 HealthSpring — PFFS: $82.61
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) In the file: Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or	Not listed in the file	Not listed in the file	$90.16 – $139.43
Physical therapy evaluation (moderate complexity): 10 of 26 insurance plan rates Aetna — MCR: $93.88 BCBS — MCR: $95.74 Clover — MCR: $97.60 Coventry — MGMCR: $94.81 Devoted Health — MCR: $92.95 Eon Health — MCR: $97.60 Georgia Assurance — MCR: $97.60 Health Net — FED: $90.16 HealthSpring — MCRHMO: $93.88 HealthSpring — PFFS: $93.88
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · modifier GP In the file: EVAL PT MOD COMPLEX	$1,379.75	$1,379.75	$184.89 – $1,241.78
Physical therapy evaluation (moderate complexity): 10 of 31 insurance plan rates Aetna — NAP: $760.66 American Steel Products — COMM: $1,172.79 Americas 1st Choice — MCR: $386.33 Amerigroup — MCD: $184.89 Centurion — PRISN: $382.05 Cigna — HMO: $500.85 Cigna — LocalPlus: $375.29 Cigna — OAP: $500.85 Cigna — PPO: $500.85 City of Eastman — COMM: $1,172.79
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · modifier GP\|CQ In the file: Physical therapy evaluation: moderate complexity, requiring these components: A history of present problem with 1-2 personal factors and/or	Not listed in the file	Not listed in the file	$79.34 – $122.69
Physical therapy evaluation (moderate complexity): 10 of 20 insurance plan rates Aetna — MCR: $82.61 BCBS — MCR: $84.25 Clover — MCR: $85.89 Coventry — MGMCR: $83.43 Devoted Health — MCR: $81.80 Eon Health — MCR: $85.89 Georgia Assurance — MCR: $85.89 Health Net — FED: $79.34 HealthSpring — MCRHMO: $82.61 HealthSpring — PFFS: $82.61
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) In the file: Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/o	Not listed in the file	Not listed in the file	$90.16 – $139.43
Physical therapy evaluation (high complexity): 10 of 26 insurance plan rates Aetna — MCR: $93.88 BCBS — MCR: $95.74 Clover — MCR: $97.60 Coventry — MGMCR: $94.81 Devoted Health — MCR: $92.95 Eon Health — MCR: $97.60 Georgia Assurance — MCR: $97.60 Health Net — FED: $90.16 HealthSpring — MCRHMO: $93.88 HealthSpring — PFFS: $93.88
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · modifier GP In the file: EVAL PT HIGH COMPLEX	$1,432.25	$1,432.25	$191.92 – $1,289.03
Physical therapy evaluation (high complexity): 10 of 31 insurance plan rates Aetna — NAP: $789.60 American Steel Products — COMM: $1,217.41 Americas 1st Choice — MCR: $401.03 Amerigroup — MCD: $191.92 Centurion — PRISN: $396.59 Cigna — HMO: $519.91 Cigna — LocalPlus: $389.57 Cigna — OAP: $519.91 Cigna — PPO: $519.91 City of Eastman — COMM: $1,217.41
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · modifier GP\|CQ In the file: Physical therapy evaluation: high complexity, requiring these components: A history of present problem with 3 or more personal factors and/o	Not listed in the file	Not listed in the file	$79.34 – $122.69
Physical therapy evaluation (high complexity): 10 of 20 insurance plan rates Aetna — MCR: $82.61 BCBS — MCR: $84.25 Clover — MCR: $85.89 Coventry — MGMCR: $83.43 Devoted Health — MCR: $81.80 Eon Health — MCR: $85.89 Georgia Assurance — MCR: $85.89 Health Net — FED: $79.34 HealthSpring — MCRHMO: $82.61 HealthSpring — PFFS: $82.61
Psychotherapy, 30 minutes CPT 90832 · Outpatient (no overnight stay) In the file: Psychotherapy, 30 minutes with patient	Not listed in the file	Not listed in the file	$404.04 – $420.88
Psychotherapy, 30 minutes: rates for 5 insurance plans Employer's Health Network — WCOMP: $412.46 Identity MCO — WorkersComp: $420.88 Prime Health — WORKERSCOMP: $404.04 Rockport United Network — WORKERSCOMP: $412.46 Synergy Health Network — WorkersComp: $420.88
Psychotherapy, 45 minutes CPT 90834 · Outpatient (no overnight stay) In the file: Psychotherapy, 45 minutes with patient	Not listed in the file	Not listed in the file	$404.04 – $420.88
Psychotherapy, 45 minutes: rates for 5 insurance plans Employer's Health Network — WCOMP: $412.46 Identity MCO — WorkersComp: $420.88 Prime Health — WORKERSCOMP: $404.04 Rockport United Network — WORKERSCOMP: $412.46 Synergy Health Network — WorkersComp: $420.88
Psychotherapy, 60 minutes CPT 90837 · Outpatient (no overnight stay) In the file: Psychotherapy, 60 minutes with patient	Not listed in the file	Not listed in the file	$404.04 – $420.88
Psychotherapy, 60 minutes: rates for 5 insurance plans Employer's Health Network — WCOMP: $412.46 Identity MCO — WorkersComp: $420.88 Prime Health — WORKERSCOMP: $404.04 Rockport United Network — WORKERSCOMP: $412.46 Synergy Health Network — WorkersComp: $420.88
Family psychotherapy, without the patient CPT 90846 · Outpatient (no overnight stay) In the file: Family psychotherapy (without the patient present), 50 minutes	Not listed in the file	Not listed in the file	$404.04 – $420.88
Family psychotherapy, without the patient: rates for 5 insurance plans Employer's Health Network — WCOMP: $412.46 Identity MCO — WorkersComp: $420.88 Prime Health — WORKERSCOMP: $404.04 Rockport United Network — WORKERSCOMP: $412.46 Synergy Health Network — WorkersComp: $420.88
Family psychotherapy, with the patient CPT 90847 · Outpatient (no overnight stay) In the file: Family psychotherapy (conjoint psychotherapy) (with patient present), 50 minutes	Not listed in the file	Not listed in the file	$404.04 – $420.88
Family psychotherapy, with the patient: rates for 5 insurance plans Employer's Health Network — WCOMP: $412.46 Identity MCO — WorkersComp: $420.88 Prime Health — WORKERSCOMP: $404.04 Rockport United Network — WORKERSCOMP: $412.46 Synergy Health Network — WorkersComp: $420.88
Group psychotherapy CPT 90853 · Outpatient (no overnight stay) In the file: Group psychotherapy (other than of a multiple-family group)	Not listed in the file	Not listed in the file	$232.61 – $242.30
Group psychotherapy: rates for 5 insurance plans Employer's Health Network — WCOMP: $237.45 Identity MCO — WorkersComp: $242.30 Prime Health — WORKERSCOMP: $232.61 Rockport United Network — WORKERSCOMP: $237.45 Synergy Health Network — WorkersComp: $242.30

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) In the file: Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19	Not listed in the file	Not listed in the file	$1,758 – $7,682.51
Removal of breast growth (open surgery): 10 of 34 insurance plan rates Aetna — HMO: $6,459 Aetna — OpenAccess: $6,459 Aetna — POS: $6,459 Aetna — PPO: $6,459 Aetna — QualifiedHealthPlan: $4,613 Americas 1st Choice — MCR: $2,205 Amerigroup — MCD: $2,365 BCBS — HIX: $6,315.83 BCBS — HMO: $7,164.61 BCBS — Pathway: $6,315.83
Removal of breast growth (open surgery) CPT 19120 · Outpatient (no overnight stay) · modifier 50 In the file: Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19	Not listed in the file	Not listed in the file	Not listed in the file
Removal of breast growth (open surgery): rates for 3 insurance plans CareSource — MGMCD: 9.92% (a percentage in the contract, not a dollar amount) Dept of Community Health — COMM: 14.6% (a percentage in the contract, not a dollar amount) Laurens County Jail — COMM: 9.73% (a percentage in the contract, not a dollar amount)
Total hip replacement CPT 27130 · Outpatient (no overnight stay) In the file: Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft	Not listed in the file	Not listed in the file	$3,224 – $39,805.80
Total hip replacement: 10 of 38 insurance plan rates Aetna — HMO: $6,761 Aetna — OpenAccess: $6,761 Aetna — POS: $6,761 Aetna — PPO: $6,761 Aetna — QualifiedHealthPlan: $4,829 Americas 1st Choice — MCR: $2,205 Amerigroup — MCD: $2,365 BCBS — HIX: $32,724.50 BCBS — HMO: $37,122.40 BCBS — Pathway: $32,724.50
Total hip replacement CPT 27130 · Inpatient (hospital stay) In the file: Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft	Not listed in the file	Not listed in the file	Not listed in the file
Total hip replacement: rates for 1 insurance plan Shared Health — MGMCR: 120% (a percentage in the contract, not a dollar amount)
Total hip replacement CPT 27130 · Outpatient (no overnight stay) · modifier 50 In the file: Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft	Not listed in the file	Not listed in the file	Not listed in the file
Total hip replacement: rates for 3 insurance plans CareSource — MGMCD: 9.92% (a percentage in the contract, not a dollar amount) Dept of Community Health — COMM: 14.6% (a percentage in the contract, not a dollar amount) Laurens County Jail — COMM: 9.73% (a percentage in the contract, not a dollar amount)
Total knee replacement CPT 27447 · Outpatient (no overnight stay) In the file: Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty)	Not listed in the file	Not listed in the file	$3,224 – $4,428
Total knee replacement: 10 of 38 insurance plan rates Aetna — HMO: $6,761 Aetna — OpenAccess: $6,761 Aetna — POS: $6,761 Aetna — PPO: $6,761 Aetna — QualifiedHealthPlan: $4,829 Americas 1st Choice — MCR: $2,205 Amerigroup — MCD: $2,365 BCBS — HIX: $32,724.50 BCBS — HMO: $37,122.40 BCBS — Pathway: $32,724.50
Total knee replacement CPT 27447 · Inpatient (hospital stay) In the file: Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty)	Not listed in the file	Not listed in the file	Not listed in the file
Total knee replacement: rates for 1 insurance plan Shared Health — MGMCR: 120% (a percentage in the contract, not a dollar amount)
Total knee replacement CPT 27447 · Outpatient (no overnight stay) · modifier 50 In the file: Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty)	Not listed in the file	Not listed in the file	Not listed in the file
Total knee replacement: rates for 3 insurance plans CareSource — MGMCD: 9.92% (a percentage in the contract, not a dollar amount) Dept of Community Health — COMM: 14.6% (a percentage in the contract, not a dollar amount) Laurens County Jail — COMM: 9.73% (a percentage in the contract, not a dollar amount)
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) In the file: Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) rele	Not listed in the file	Not listed in the file	$1,182 – $7,512
Shoulder arthroscopy: shaving of shoulder bone: 10 of 24 insurance plan rates Aetna — HMO: $9,398 Aetna — OpenAccess: $9,398 Aetna — POS: $9,398 Aetna — PPO: $9,398 Aetna — QualifiedHealthPlan: $6,713 Americas 1st Choice — MCR: $4,400 Amerigroup — MCD: $2,365 Centurion — PRISN: $7,512 Cigna — HMO: $10,148 Cigna — LocalPlus: $7,390
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · modifier 50 In the file: Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) rele	Not listed in the file	Not listed in the file	Not listed in the file
Shoulder arthroscopy: shaving of shoulder bone: rates for 3 insurance plans CareSource — MGMCD: 9.92% (a percentage in the contract, not a dollar amount) Dept of Community Health — COMM: 14.6% (a percentage in the contract, not a dollar amount) Laurens County Jail — COMM: 9.73% (a percentage in the contract, not a dollar amount)
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) In the file: Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articula	Not listed in the file	Not listed in the file	$2,108 – $7,992
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 34 insurance plan rates Aetna — HMO: $9,398 Aetna — OpenAccess: $9,398 Aetna — POS: $9,398 Aetna — PPO: $9,398 Aetna — QualifiedHealthPlan: $6,713 Americas 1st Choice — MCR: $4,400 Amerigroup — MCD: $2,365 BCBS — HIX: $6,315.83 BCBS — HMO: $7,164.61 BCBS — Pathway: $6,315.83
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · modifier 50 In the file: Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articula	Not listed in the file	Not listed in the file	Not listed in the file
Knee arthroscopy: removal of torn cartilage (meniscus): rates for 3 insurance plans CareSource — MGMCD: 9.92% (a percentage in the contract, not a dollar amount) Dept of Community Health — COMM: 14.6% (a percentage in the contract, not a dollar amount) Laurens County Jail — COMM: 9.73% (a percentage in the contract, not a dollar amount)
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) In the file: Tonsillectomy and adenoidectomy; younger than age 12	Not listed in the file	Not listed in the file	$1,758 – $10,668
Removal of tonsils and adenoids (under age 12): 10 of 33 insurance plan rates Aetna — HMO: $6,459 Aetna — OpenAccess: $6,459 Aetna — POS: $6,459 Aetna — PPO: $6,459 Aetna — QualifiedHealthPlan: $4,613 Americas 1st Choice — MCR: $2,205 Amerigroup — MCD: $2,365 BCBS — HIX: $8,770.16 BCBS — HMO: $9,948.79 BCBS — Pathway: $8,770.16
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · modifier 50 In the file: Tonsillectomy and adenoidectomy; younger than age 12	Not listed in the file	Not listed in the file	Not listed in the file
Removal of tonsils and adenoids (under age 12): rates for 3 insurance plans CareSource — MGMCD: 9.92% (a percentage in the contract, not a dollar amount) Dept of Community Health — COMM: 14.6% (a percentage in the contract, not a dollar amount) Laurens County Jail — COMM: 9.73% (a percentage in the contract, not a dollar amount)
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) In the file: Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (sep	Not listed in the file	Not listed in the file	$3,224 – $7,512
Upper GI endoscopy (diagnostic): 10 of 33 insurance plan rates Aetna — HMO: $3,633 Aetna — OpenAccess: $3,633 Aetna — POS: $3,633 Aetna — PPO: $3,633 Aetna — QualifiedHealthPlan: $2,595 Americas 1st Choice — MCR: $2,205 Amerigroup — MCD: $2,365 BCBS — HIX: $5,988.60 BCBS — HMO: $6,793.39 BCBS — Pathway: $5,988.60
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · modifier 50 In the file: Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (sep	Not listed in the file	Not listed in the file	Not listed in the file
Upper GI endoscopy (diagnostic): rates for 3 insurance plans CareSource — MGMCD: 9.92% (a percentage in the contract, not a dollar amount) Dept of Community Health — COMM: 14.6% (a percentage in the contract, not a dollar amount) Laurens County Jail — COMM: 9.73% (a percentage in the contract, not a dollar amount)
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) In the file: Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple	Not listed in the file	Not listed in the file	$1,230 – $7,512
Upper GI endoscopy with biopsy: 10 of 33 insurance plan rates Aetna — HMO: $3,633 Aetna — OpenAccess: $3,633 Aetna — POS: $3,633 Aetna — PPO: $3,633 Aetna — QualifiedHealthPlan: $2,595 Americas 1st Choice — MCR: $2,205 Amerigroup — MCD: $2,365 BCBS — HIX: $5,988.60 BCBS — HMO: $6,793.39 BCBS — Pathway: $5,988.60
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · modifier 50 In the file: Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple	Not listed in the file	Not listed in the file	Not listed in the file
Upper GI endoscopy with biopsy: rates for 3 insurance plans CareSource — MGMCD: 9.92% (a percentage in the contract, not a dollar amount) Dept of Community Health — COMM: 14.6% (a percentage in the contract, not a dollar amount) Laurens County Jail — COMM: 9.73% (a percentage in the contract, not a dollar amount)
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) In the file: Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)	Not listed in the file	Not listed in the file	$3,224 – $4,428
Colonoscopy (diagnostic): 10 of 33 insurance plan rates Aetna — HMO: $3,633 Aetna — OpenAccess: $3,633 Aetna — POS: $3,633 Aetna — PPO: $3,633 Aetna — QualifiedHealthPlan: $2,595 Americas 1st Choice — MCR: $2,205 Amerigroup — MCD: $2,365 BCBS — HIX: $5,988.60 BCBS — HMO: $6,793.39 BCBS — Pathway: $5,988.60
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · modifier 50 In the file: Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure)	Not listed in the file	Not listed in the file	Not listed in the file
Colonoscopy (diagnostic): rates for 3 insurance plans CareSource — MGMCD: 9.92% (a percentage in the contract, not a dollar amount) Dept of Community Health — COMM: 14.6% (a percentage in the contract, not a dollar amount) Laurens County Jail — COMM: 9.73% (a percentage in the contract, not a dollar amount)
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) In the file: Colonoscopy, flexible; with biopsy, single or multiple	Not listed in the file	Not listed in the file	$1,150 – $7,512
Colonoscopy with biopsy: 10 of 33 insurance plan rates Aetna — HMO: $3,633 Aetna — OpenAccess: $3,633 Aetna — POS: $3,633 Aetna — PPO: $3,633 Aetna — QualifiedHealthPlan: $2,595 Americas 1st Choice — MCR: $2,205 Amerigroup — MCD: $2,365 BCBS — HIX: $6,097.67 BCBS — HMO: $6,917.13 BCBS — Pathway: $6,097.67
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · modifier 50 In the file: Colonoscopy, flexible; with biopsy, single or multiple	Not listed in the file	Not listed in the file	Not listed in the file
Colonoscopy with biopsy: rates for 3 insurance plans CareSource — MGMCD: 9.92% (a percentage in the contract, not a dollar amount) Dept of Community Health — COMM: 14.6% (a percentage in the contract, not a dollar amount) Laurens County Jail — COMM: 9.73% (a percentage in the contract, not a dollar amount)
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) In the file: Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique	Not listed in the file	Not listed in the file	$1,230 – $7,512
Colonoscopy with removal of polyps (snare): 10 of 33 insurance plan rates Aetna — HMO: $3,633 Aetna — OpenAccess: $3,633 Aetna — POS: $3,633 Aetna — PPO: $3,633 Aetna — QualifiedHealthPlan: $2,595 Americas 1st Choice — MCR: $2,205 Amerigroup — MCD: $2,365 BCBS — HIX: $6,097.67 BCBS — HMO: $6,917.13 BCBS — Pathway: $6,097.67
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · modifier 50 In the file: Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique	Not listed in the file	Not listed in the file	Not listed in the file
Colonoscopy with removal of polyps (snare): rates for 3 insurance plans CareSource — MGMCD: 9.92% (a percentage in the contract, not a dollar amount) Dept of Community Health — COMM: 14.6% (a percentage in the contract, not a dollar amount) Laurens County Jail — COMM: 9.73% (a percentage in the contract, not a dollar amount)
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) In the file: Colonoscopy, flexible; with endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and	Not listed in the file	Not listed in the file	$1,230 – $7,512
Ultrasound of the lower bowel by endoscope: 10 of 33 insurance plan rates Aetna — HMO: $3,633 Aetna — OpenAccess: $3,633 Aetna — POS: $3,633 Aetna — PPO: $3,633 Aetna — QualifiedHealthPlan: $2,595 Americas 1st Choice — MCR: $2,205 Amerigroup — MCD: $2,365 BCBS — HIX: $6,097.67 BCBS — HMO: $6,917.13 BCBS — Pathway: $6,097.67
Ultrasound of the lower bowel by endoscope CPT 45391 · Outpatient (no overnight stay) · modifier 50 In the file: Colonoscopy, flexible; with endoscopic ultrasound examination limited to the rectum, sigmoid, descending, transverse, or ascending colon and	Not listed in the file	Not listed in the file	Not listed in the file
Ultrasound of the lower bowel by endoscope: rates for 3 insurance plans CareSource — MGMCD: 9.92% (a percentage in the contract, not a dollar amount) Dept of Community Health — COMM: 14.6% (a percentage in the contract, not a dollar amount) Laurens County Jail — COMM: 9.73% (a percentage in the contract, not a dollar amount)
Screening colonoscopy (not high risk) HCPCS G0121 · Outpatient (no overnight stay) In the file: Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk	Not listed in the file	Not listed in the file	$1,116 – $7,284.45
Screening colonoscopy (not high risk): 10 of 22 insurance plan rates Aetna — HMO: $3,633 Aetna — OpenAccess: $3,633 Aetna — POS: $3,633 Aetna — PPO: $3,633 Aetna — QualifiedHealthPlan: $2,595 BCBS — HIX: $5,988.60 BCBS — HMO: $6,793.39 BCBS — Pathway: $5,988.60 BCBS — PPO: $7,284.45 Core Resources — COMM: $7,027.20
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) In the file: Laparoscopy, surgical; cholecystectomy	Not listed in the file	Not listed in the file	$7,512
Gallbladder removal by laparoscope: 10 of 33 insurance plan rates Aetna — HMO: $7,966 Aetna — OpenAccess: $7,966 Aetna — POS: $7,966 Aetna — PPO: $7,966 Aetna — QualifiedHealthPlan: $5,690 Americas 1st Choice — MCR: $4,400 Amerigroup — MCD: $2,365 BCBS — HIX: $9,097.42 BCBS — HMO: $10,320 BCBS — Pathway: $9,097.42
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · modifier 50 In the file: Laparoscopy, surgical; cholecystectomy	Not listed in the file	Not listed in the file	Not listed in the file
Gallbladder removal by laparoscope: rates for 3 insurance plans CareSource — MGMCD: 9.92% (a percentage in the contract, not a dollar amount) Dept of Community Health — COMM: 14.6% (a percentage in the contract, not a dollar amount) Laurens County Jail — COMM: 9.73% (a percentage in the contract, not a dollar amount)
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) In the file: Repair initial inguinal hernia, age 5 years or older; reducible	Not listed in the file	Not listed in the file	$3,224 – $4,428
Groin (inguinal) hernia repair, age 5 or older: 10 of 33 insurance plan rates Aetna — HMO: $6,761 Aetna — OpenAccess: $6,761 Aetna — POS: $6,761 Aetna — PPO: $6,761 Aetna — QualifiedHealthPlan: $4,829 Americas 1st Choice — MCR: $4,400 Amerigroup — MCD: $2,365 BCBS — HIX: $6,315.83 BCBS — HMO: $7,164.61 BCBS — Pathway: $6,315.83
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · modifier 50 In the file: Repair initial inguinal hernia, age 5 years or older; reducible	Not listed in the file	Not listed in the file	Not listed in the file
Groin (inguinal) hernia repair, age 5 or older: rates for 3 insurance plans CareSource — MGMCD: 9.92% (a percentage in the contract, not a dollar amount) Dept of Community Health — COMM: 14.6% (a percentage in the contract, not a dollar amount) Laurens County Jail — COMM: 9.73% (a percentage in the contract, not a dollar amount)
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) In the file: Biopsy, prostate; needle or punch, single or multiple, any approach	Not listed in the file	Not listed in the file	$1,230 – $7,417.15
Prostate biopsy: 10 of 16 insurance plan rates BCBS — HIX: $6,097.67 BCBS — HMO: $6,917.13 BCBS — Pathway: $6,097.67 BCBS — PPO: $7,417.15 Core Resources — COMM: $7,155.20 Employer's Health Network — WCOMP: $4,914.84 Friday Health — HIX: $3,224 Health One Alliance — COMMHIX: $1,230 Identity MCO — WorkersComp: $5,015.14 Memorial Health Plan — COASTALHEALTHPLAN: $1,898
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · modifier 50 In the file: Biopsy, prostate; needle or punch, single or multiple, any approach	Not listed in the file	Not listed in the file	Not listed in the file
Prostate biopsy: rates for 3 insurance plans CareSource — MGMCD: 9.92% (a percentage in the contract, not a dollar amount) Dept of Community Health — COMM: 14.6% (a percentage in the contract, not a dollar amount) Laurens County Jail — COMM: 9.73% (a percentage in the contract, not a dollar amount)
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) In the file: Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed;	Not listed in the file	Not listed in the file	$1,150 – $24,910
Prostate removal by laparoscope (radical prostatectomy): 10 of 33 insurance plan rates Aetna — HMO: $11,584 Aetna — OpenAccess: $11,584 Aetna — POS: $11,584 Aetna — PPO: $11,584 Aetna — QualifiedHealthPlan: $8,274 Americas 1st Choice — MCR: $2,205 Amerigroup — MCD: $2,365 BCBS — HIX: $10,460.90 BCBS — HMO: $11,866.80 BCBS — Pathway: $10,460.90
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · modifier 50 In the file: Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed;	Not listed in the file	Not listed in the file	Not listed in the file
Prostate removal by laparoscope (radical prostatectomy): rates for 3 insurance plans CareSource — MGMCD: 9.92% (a percentage in the contract, not a dollar amount) Dept of Community Health — COMM: 14.6% (a percentage in the contract, not a dollar amount) Laurens County Jail — COMM: 9.73% (a percentage in the contract, not a dollar amount)
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) In the file: Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C	Not listed in the file	Not listed in the file	$6,097.67 – $7,512
Hysteroscopy with biopsy of the uterus lining: 10 of 34 insurance plan rates Aetna — HMO: $6,459 Aetna — OpenAccess: $6,459 Aetna — POS: $6,459 Aetna — PPO: $6,459 Aetna — QualifiedHealthPlan: $4,613 Americas 1st Choice — MCR: $4,400 Amerigroup — MCD: $2,365 BCBS — HIX: $6,097.67 BCBS — HMO: $6,917.13 BCBS — Pathway: $6,097.67
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · modifier 50 In the file: Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C	Not listed in the file	Not listed in the file	Not listed in the file
Hysteroscopy with biopsy of the uterus lining: rates for 3 insurance plans CareSource — MGMCD: 9.92% (a percentage in the contract, not a dollar amount) Dept of Community Health — COMM: 14.6% (a percentage in the contract, not a dollar amount) Laurens County Jail — COMM: 9.73% (a percentage in the contract, not a dollar amount)
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neur	$5,459	$5,459	$1,741.50 – $2,550
Spinal injection, lower back (epidural), with imaging guidance: 10 of 28 insurance plan rates Aetna — HMO: $3,633 Aetna — OpenAccess: $3,633 Aetna — POS: $3,633 Aetna — PPO: $3,633 Aetna — QualifiedHealthPlan: $2,595 Americas 1st Choice — MCR: $2,205 Amerigroup — MCD: $2,365 BCBS — HIX: $5,988.60 BCBS — HMO: $6,793.39 BCBS — Pathway: $5,988.60
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) In the file: INJ EPI L/S W IMAGING	$5,459	$5,459	$1,200.98 – $4,913.10
Spinal injection, lower back (epidural), with imaging guidance: 10 of 14 insurance plan rates Aetna — NAP: $3,009.55 American Steel Products — COMM: $4,640.15 City of Eastman — COMM: $4,640.15 Dodge Co Board of Commissioners — COMM: $4,640.15 Dodge County Hospital — COMM: $2,729.50 Graham Brothers Construction — COMM: $4,640.15 Health One Alliance — COMMHIX: $2,456.55 Leavitt Risk Partners — COMM: $1,637.70 Memorial Health Plan — EMPLOYEEPLAN: $1,200.98 MultiPlan — Complementary: $4,913.10
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · modifier 50 In the file: Injection(s), of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neur	$5,459	$5,459	Not listed in the file
Spinal injection, lower back (epidural), with imaging guidance: rates for 3 insurance plans CareSource — MGMCD: 9.92% (a percentage in the contract, not a dollar amount) Dept of Community Health — COMM: 14.6% (a percentage in the contract, not a dollar amount) Laurens County Jail — COMM: 9.73% (a percentage in the contract, not a dollar amount)
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) In the file: Injection(s), anesthetic agent(s) and/or steroid; transforaminal epidural, with imaging guidance (fluoroscopy or CT), lumbar or sacral, sing	Not listed in the file	Not listed in the file	$1,116 – $7,512
Nerve root injection, lower back, with imaging guidance: 10 of 33 insurance plan rates Aetna — HMO: $3,633 Aetna — OpenAccess: $3,633 Aetna — POS: $3,633 Aetna — PPO: $3,633 Aetna — QualifiedHealthPlan: $2,595 Americas 1st Choice — MCR: $2,205 Amerigroup — MCD: $2,365 BCBS — HIX: $5,988.60 BCBS — HMO: $6,793.39 BCBS — Pathway: $5,988.60
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · modifier RT In the file: BLOCK L-SPINE SGL RT	$5,459	$5,459	$1,200.98 – $4,913.10
Nerve root injection, lower back, with imaging guidance: 10 of 13 insurance plan rates Aetna — NAP: $3,009.55 American Steel Products — COMM: $4,640.15 City of Eastman — COMM: $4,640.15 Dodge Co Board of Commissioners — COMM: $4,640.15 Dodge County Hospital — COMM: $2,729.50 Graham Brothers Construction — COMM: $4,640.15 Leavitt Risk Partners — COMM: $1,637.70 Memorial Health Plan — EMPLOYEEPLAN: $1,200.98 MultiPlan — Complementary: $4,913.10 MultiPlan — Primary: $4,913.10
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · modifier LT In the file: BLOCK L-SPINE SGL LT	$5,459	$5,459	$1,200.98 – $4,913.10
Nerve root injection, lower back, with imaging guidance: 10 of 13 insurance plan rates Aetna — NAP: $3,009.55 American Steel Products — COMM: $4,640.15 City of Eastman — COMM: $4,640.15 Dodge Co Board of Commissioners — COMM: $4,640.15 Dodge County Hospital — COMM: $2,729.50 Graham Brothers Construction — COMM: $4,640.15 Leavitt Risk Partners — COMM: $1,637.70 Memorial Health Plan — EMPLOYEEPLAN: $1,200.98 MultiPlan — Complementary: $4,913.10 MultiPlan — Primary: $4,913.10
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) In the file: Neuroplasty and/or transposition; median nerve at carpal tunnel	Not listed in the file	Not listed in the file	$3,224 – $7,512
Carpal tunnel release: 10 of 33 insurance plan rates Aetna — HMO: $3,633 Aetna — OpenAccess: $3,633 Aetna — POS: $3,633 Aetna — PPO: $3,633 Aetna — QualifiedHealthPlan: $2,595 Americas 1st Choice — MCR: $4,400 Amerigroup — MCD: $2,365 BCBS — HIX: $6,097.67 BCBS — HMO: $6,917.13 BCBS — Pathway: $6,097.67
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · modifier 50 In the file: Neuroplasty and/or transposition; median nerve at carpal tunnel	Not listed in the file	Not listed in the file	Not listed in the file
Carpal tunnel release: rates for 3 insurance plans CareSource — MGMCD: 9.92% (a percentage in the contract, not a dollar amount) Dept of Community Health — COMM: 14.6% (a percentage in the contract, not a dollar amount) Laurens County Jail — COMM: 9.73% (a percentage in the contract, not a dollar amount)
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) In the file: Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); laser surgery (eg, YAG laser) (1 or	Not listed in the file	Not listed in the file	$1,116 – $7,512
Laser treatment of clouding after cataract surgery: 10 of 33 insurance plan rates Aetna — HMO: $3,633 Aetna — OpenAccess: $3,633 Aetna — POS: $3,633 Aetna — PPO: $3,633 Aetna — QualifiedHealthPlan: $2,595 Americas 1st Choice — MCR: $2,205 Amerigroup — MCD: $2,365 BCBS — HIX: $5,988.60 BCBS — HMO: $6,793.39 BCBS — Pathway: $5,988.60
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · modifier 50 In the file: Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); laser surgery (eg, YAG laser) (1 or	Not listed in the file	Not listed in the file	Not listed in the file
Laser treatment of clouding after cataract surgery: rates for 3 insurance plans CareSource — MGMCD: 9.92% (a percentage in the contract, not a dollar amount) Dept of Community Health — COMM: 14.6% (a percentage in the contract, not a dollar amount) Laurens County Jail — COMM: 9.73% (a percentage in the contract, not a dollar amount)
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) In the file: Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irriga	Not listed in the file	Not listed in the file	$1,150 – $7,512
Cataract removal with lens implant: 10 of 33 insurance plan rates Aetna — HMO: $6,761 Aetna — OpenAccess: $6,761 Aetna — POS: $6,761 Aetna — PPO: $6,761 Aetna — QualifiedHealthPlan: $4,829 Americas 1st Choice — MCR: $2,205 Amerigroup — MCD: $2,365 BCBS — HIX: $6,097.67 BCBS — HMO: $6,917.13 BCBS — Pathway: $6,097.67
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · modifier 50 In the file: Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irriga	Not listed in the file	Not listed in the file	Not listed in the file
Cataract removal with lens implant: rates for 3 insurance plans CareSource — MGMCD: 9.92% (a percentage in the contract, not a dollar amount) Dept of Community Health — COMM: 14.6% (a percentage in the contract, not a dollar amount) Laurens County Jail — COMM: 9.73% (a percentage in the contract, not a dollar amount)

Pregnancy and childbirth

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) In the file: Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care	Not listed in the file	Not listed in the file	$3,224 – $4,428
Vaginal delivery, with care before and after: 10 of 16 insurance plan rates Americas 1st Choice — MCR: $2,205 Amerigroup — MCD: $2,365 BCBS — HIX: $6,315.83 BCBS — HMO: $7,164.61 BCBS — Pathway: $6,315.83 BCBS — PPO: $7,682.51 Centurion — PRISN: $7,512 Cigna — HMO: $4,428 Cigna — LocalPlus: $3,224 Cigna — OAP: $4,428
Vaginal delivery, with care before and after CPT 59400 · Outpatient (no overnight stay) · modifier 50 In the file: Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care	Not listed in the file	Not listed in the file	Not listed in the file
Vaginal delivery, with care before and after: rates for 3 insurance plans CareSource — MGMCD: 9.92% (a percentage in the contract, not a dollar amount) Dept of Community Health — COMM: 14.6% (a percentage in the contract, not a dollar amount) Laurens County Jail — COMM: 9.73% (a percentage in the contract, not a dollar amount)
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) In the file: Routine obstetric care including antepartum care, cesarean delivery, and postpartum care	Not listed in the file	Not listed in the file	$3,224 – $7,512
Cesarean delivery (C-section), with care before and after: 10 of 16 insurance plan rates Americas 1st Choice — MCR: $2,205 Amerigroup — MCD: $2,365 BCBS — HIX: $6,315.83 BCBS — HMO: $7,164.61 BCBS — Pathway: $6,315.83 BCBS — PPO: $7,682.51 Centurion — PRISN: $7,512 Cigna — HMO: $4,428 Cigna — LocalPlus: $3,224 Cigna — OAP: $4,428
Cesarean delivery (C-section), with care before and after CPT 59510 · Outpatient (no overnight stay) · modifier 50 In the file: Routine obstetric care including antepartum care, cesarean delivery, and postpartum care	Not listed in the file	Not listed in the file	Not listed in the file
Cesarean delivery (C-section), with care before and after: rates for 3 insurance plans CareSource — MGMCD: 9.92% (a percentage in the contract, not a dollar amount) Dept of Community Health — COMM: 14.6% (a percentage in the contract, not a dollar amount) Laurens County Jail — COMM: 9.73% (a percentage in the contract, not a dollar amount)
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) In the file: Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after p	Not listed in the file	Not listed in the file	$3,224 – $7,682.51
Vaginal delivery after a previous C-section, with care before and after: 10 of 16 insurance plan rates Americas 1st Choice — MCR: $2,205 Amerigroup — MCD: $2,365 BCBS — HIX: $6,315.83 BCBS — HMO: $7,164.61 BCBS — Pathway: $6,315.83 BCBS — PPO: $7,682.51 Centurion — PRISN: $7,512 Cigna — HMO: $4,428 Cigna — LocalPlus: $3,224 Cigna — OAP: $4,428
Vaginal delivery after a previous C-section, with care before and after CPT 59610 · Outpatient (no overnight stay) · modifier 50 In the file: Routine obstetric care including antepartum care, vaginal delivery (with or without episiotomy, and/or forceps) and postpartum care, after p	Not listed in the file	Not listed in the file	Not listed in the file
Vaginal delivery after a previous C-section, with care before and after: rates for 3 insurance plans CareSource — MGMCD: 9.92% (a percentage in the contract, not a dollar amount) Dept of Community Health — COMM: 14.6% (a percentage in the contract, not a dollar amount) Laurens County Jail — COMM: 9.73% (a percentage in the contract, not a dollar amount)

Hospital stays (whole stay, MS-DRG)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Heart valve or major heart-chest surgery with heart catheterization, with major complications MS-DRG 216 · Inpatient (hospital stay) In the file: CARDIAC VALVE AND OTHER MAJOR CARDIOTHORACIC PROCEDURES WITH CARDIAC CATHETERIZA	Not listed in the file	Not listed in the file	$71,223.67
Heart valve or major heart-chest surgery with heart catheterization, with major complications: 10 of 70 insurance plan rates Aetna — HMO: $215,074.86 Aetna — MCR: $65,996.25 Aetna — OpenAccess: $215,074.86 Aetna — POS: $215,074.86 Aetna — PPO: $215,074.86 Aetna — QualifiedHealthPlan: $153,629.09 Americas 1st Choice — MCR: $71,223.67 BCBS — HIX: $168,892.22 BCBS — HMO: $191,589.29 BCBS — MCR: $67,303.10
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT	Not listed in the file	Not listed in the file	$15,300.64
Hip or knee replacement (major joint of the leg), without major complications: 10 of 70 insurance plan rates Aetna — HMO: $39,561 Aetna — MCR: $14,177.65 Aetna — OpenAccess: $39,561 Aetna — POS: $39,561 Aetna — PPO: $39,561 Aetna — QualifiedHealthPlan: $28,258 Americas 1st Choice — MCR: $15,300.64 BCBS — HIX: $33,300.92 BCBS — HMO: $37,776.16 BCBS — MCR: $14,458.40
Hip or knee replacement (major joint of the leg), without major complications MS-DRG 470 · Inpatient (hospital stay) In the file: MAJOR HIP AND KNEE JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY WITHOUT One Day Stay	Not listed in the file	Not listed in the file	$9,769.54 – $11,883.60
Hip or knee replacement (major joint of the leg), without major complications: rates for 9 insurance plans Aetna — HMO: $42,406.87 Aetna — OpenAccess: $42,406.87 Aetna — POS: $42,406.87 Aetna — PPO: $42,406.87 Aetna — QualifiedHealthPlan: $30,291.45 BCBS — HIX: $9,769.54 BCBS — HMO: $11,082.50 BCBS — Pathway: $9,769.54 BCBS — PPO: $11,883.60
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$18,949.14
Neck (cervical) spinal fusion, without complications: 10 of 70 insurance plan rates Aetna — HMO: $33,684 Aetna — MCR: $17,558.38 Aetna — OpenAccess: $33,684 Aetna — POS: $33,684 Aetna — PPO: $33,684 Aetna — QualifiedHealthPlan: $24,061 Americas 1st Choice — MCR: $18,949.14 BCBS — HIX: $42,147.09 BCBS — HMO: $47,811.15 BCBS — MCR: $17,906.07
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC Pediatric	Not listed in the file	Not listed in the file	$38,338.18 – $53,671.98
Neck (cervical) spinal fusion, without complications: rates for 5 insurance plans Aetna — HMO: $53,671.98 Aetna — OpenAccess: $53,671.98 Aetna — POS: $53,671.98 Aetna — PPO: $53,671.98 Aetna — QualifiedHealthPlan: $38,338.18
Neck (cervical) spinal fusion, without complications MS-DRG 473 · Inpatient (hospital stay) In the file: CERVICAL SPINAL FUSION WITHOUT CC/MCC One Day Stay	Not listed in the file	Not listed in the file	$9,769.54 – $11,883.60
Neck (cervical) spinal fusion, without complications: rates for 4 insurance plans BCBS — HIX: $9,769.54 BCBS — HMO: $11,082.50 BCBS — Pathway: $9,769.54 BCBS — PPO: $11,883.60
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC	Not listed in the file	Not listed in the file	$10,400.36
Uterus and ovary surgery (not for cancer), without complications: 10 of 70 insurance plan rates Aetna — HMO: $23,718.46 Aetna — MCR: $9,637.03 Aetna — OpenAccess: $23,718.46 Aetna — POS: $23,718.46 Aetna — PPO: $23,718.46 Aetna — QualifiedHealthPlan: $16,941.76 Americas 1st Choice — MCR: $10,400.36 BCBS — HIX: $21,419.69 BCBS — HMO: $24,298.24 BCBS — MCR: $9,827.86
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC Pediatric	Not listed in the file	Not listed in the file	$19,483.95 – $27,276.79
Uterus and ovary surgery (not for cancer), without complications: rates for 5 insurance plans Aetna — HMO: $27,276.79 Aetna — OpenAccess: $27,276.79 Aetna — POS: $27,276.79 Aetna — PPO: $27,276.79 Aetna — QualifiedHealthPlan: $19,483.95
Uterus and ovary surgery (not for cancer), without complications MS-DRG 743 · Inpatient (hospital stay) In the file: UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC One Day Stay	Not listed in the file	Not listed in the file	$9,769.54 – $11,883.60
Uterus and ovary surgery (not for cancer), without complications: rates for 4 insurance plans BCBS — HIX: $9,769.54 BCBS — HMO: $11,082.50 BCBS — Pathway: $9,769.54 BCBS — PPO: $11,883.60

Source: Fairview Park Hospital’s standard charges file (stctrprodsnsvc00455826e6.blob.core.windows.net, JSON, CMS template 3.0.0; it can be a very large file), last updated by the hospital on September 1, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

Found through the hospital’s cms-hpt.txt file, as required by the federal hospital price transparency rule (CMS). We show a selection of common services; the file has every item and service.

Hospital information

Hospital type	Acute Care Hospital
Address	200 Industrial Boulevard, Dublin, GA 31021
County	Laurens County
State	Georgia
Phone	(478) 274‑3100
Emergency services	Yes
Ownership	Proprietary
Medicare overall rating	4 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	110125
Name in Medicare records	FAIRVIEW PARK HOSPITAL
Profile level	Medicare data + hospital website
Main phone on the hospital’s website	(478) 275‑2000^[4]
Official website	fairviewparkhospital.com
Corrections	Report an error or suggest an update →

Sources

Hospital General Information — Centers for Medicare & Medicaid Services (CMS), data updated 2026-10-26, retrieved 2026-11-13
Medicare Care Compare — official Medicare profile of this hospital
U.S. Census Bureau Geocoder — map position used for distances

From the hospital’s website

Numbers match the citations above. Checked 2026-10-30.

Fairview Park Hospital — fairviewparkhospital.com
Imaging Services | Fairview Park Hospital — fairviewparkhospital.com
Wound Care | Fairview Park Hospital — fairviewparkhospital.com
Women's Care | Fairview Park Hospital — fairviewparkhospital.com
Emergency Care | Fairview Park Hospital — fairviewparkhospital.com
Inpatient Physical Rehabilitation | Fairview Park Hospital — fairviewparkhospital.com
Outpatient Physical Rehabilitation | Fairview Park Hospital — fairviewparkhospital.com
Orthopedics | Fairview Park Hospital — fairviewparkhospital.com
For Visitors | Fairview Park Hospital — fairviewparkhospital.com
Cardiology | Fairview Park Hospital — fairviewparkhospital.com
Surgical Care | Fairview Park Hospital — fairviewparkhospital.com
Weight Loss Surgery | Fairview Park Hospital — fairviewparkhospital.com
Cardiac Rehabilitation | Fairview Park Hospital — fairviewparkhospital.com
Sleep Disorders | Fairview Park Hospital — fairviewparkhospital.com

Fairview Park Hospital

Summary

Profile from official sources

At a glance